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UNITED
STATES SECURITIES AND EXCHANGE COMMISSION STATEMENT
OF CHANGES IN BENEFICIAL OWNERSHIP |
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OMB Number: 3235-0287 | |||
Expires: January 31, 2005 | |||
[_] | Check
box if no longer subject to Section 16. Form 4 or Form 5 obligations may
continue. See instructions 1(b). |
Estimated
average burden hours per response. . . 0.5 |
1.
Name and Address of Reporting Person* Mickel Buck A. |
2.
Issuer Name and Ticker or Trading Symbol RSI Holdings, Inc. - RSII |
6. Relationship of
Reporting Person(s) to Issuer |
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28 E. Court Street |
3.
I.R.S. Identification Number of Reporting Person, if an entity (voluntary) |
4.
Statement for Month/Day/Year December 24, 2002 |
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Greenville SC 29601 |
5.
If Amendment, Date of Original (Month/Day/Year) |
7.
Individual or Joint/Group Filing (Check Applicable Line) [X] Form filed by One Reporting Person [_] Form filed by More than One Reporting Person |
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(City) (State) (Zip) | Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr. 3) |
2. Trans- |
2A.
Deemed Execution Date, if any (mm/dd/yy |
3. Transaction Code (Instr. 8) |
4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following Reported Transaction (Instr. 3 and 4) |
6. Owner- ship Form: Direct (D) or Indirect (I) (Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | Amount |
(A) or (D) |
Price | ||||||
Common Stock, $.01 Par Value ("Common Stock") | 11/6/2002 | G | V | 150,000(1) | D | N/A | ||||
Common Stock | 12/6/2002 | G | V | 3,000 | D | N/A | ||||
Common Stock | 12/14/2002 | G | V | 50,000 | D | N/A | 3,087,309 | D | ||
Common Stock | 150,000(1) | I | By self for child |
(1) Represents transfer of shares to child under Uniform Gifts to Minors Act
Reminder: Report
on a separate line for each class of securities beneficially owned directly
or indirectly. |
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Persons who respond to the collection of information contained in this form
are not required to respond unless the form displays a currently vaild OMB
Number. |
(Over) SEC 1474 (9-02) |
FORM
4 (continued) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities) |
1.Title of Derivative Security (Instr.3) |
2. Conversion or Exercise Price of Derivative Security |
3. Transaction Date (Month/ Day/ Year) |
4. Transaction
Code (Instr. 8) |
5. Number
of Derivative Securities Acquired (A) or Disposed of(D) (Instr. 3, 4 and 5) |
6. Date
Exercisable and Expiration Date (Month/Day/Year) |
7. Title
and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9.Number of |
10. Owner- ship Form of Deriv- ative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Benefi- cial Owner- ship (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable |
Expiration Date |
Title | Amount
or Number of Shares |
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Stock Option (Right to Buy) | $1.125 | (1) | 7/2/07 | Common Stock | 5,000 | 5,000 | D | |||||||
Stock Option (Right to Buy | $.57 | (1) | 4/22/08 | Common Stock | 8,333 | 8,333 | D | |||||||
Stock Option (Right to Buy) | $.15 | (1) | 1/21/09 | Common Stock | 13,333 | 13,333 | D | |||||||
Stock Option (Right to Buy | $.077 | 6/10/03 | 6/10/07 | Common Stock | 300,000 | 300,000 | D | |||||||
Explanation
of Responses: (1) This option granted to the Reporting Person by the board of directors of RSI Holdings, Inc. is fully vested and exercisable. |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | /s/
Buck A. Mickel
**Signature of Reporting Person |
January 6, 2003
Date |
Note: | File three
copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
Potential
persons who are to respond to the collection of information contained in
this form are not required to respond unless the form displays a currently valid OMB Number. |
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