FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
[ ] Form 3 Holdings Reported [ X ] Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549 |
OMB APPROVAL
OMB Number: 3235-0362 Estimated average burden hours per response... 1.0 |
|
|
|
1. Name and Address of Reporting Person
*
|
2. Issuer Name and Ticker or Trading Symbol DOLLAR GENERAL CORP [DG] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__ X __ Officer (give title below) _____ Other (specify below) Executive Vice President |
|
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
|
|
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities) |
|||||||||||||||
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any |
4. Trans. 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
(MM/DD/YYYY) |
7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4) |
11. Nature of Indirect Beneficial Ownership
(Instr. 4) |
||||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||||
Phantom Stock | 2/3/2003 | A4 | 168.9825 | (2) | (3) | Common Stock | 168.9825 | $11.31 | 37995.7924 | D | |||||
Phantom Stock | 2/10/2003 | A4 | 309.2215 | (2) | (3) | Common Stock | 309.2215 | $11.06 | 38305.0139 | D | |||||
Phantom Stock | 2/26/2003 | A4 | 6.9341 | (2) | (3) | Common Stock | 6.9341 | $12.94 | 38311.948 | D | |||||
Phantom Stock | 2/28/2003 | A4 | 1064.9443 | (2) | (3) | Common Stock | 1064.9443 | $10.41 | 39376.8923 | D | |||||
Phantom Stock | 3/18/2003 | A4 | 872.1774 | (2) | (3) | Common Stock | 872.1774 | $12.52 | 40249.0697 | D | |||||
Phantom Stock | 3/25/2003 | A4 | 79.1917 | (2) | (3) | Common Stock | 79.1917 | $12.73 | 40427.3832 (4) | D | |||||
Phantom Stock | 4/9/2003 | A4 | 886.8521 | (2) | (3) | Common Stock | 886.8521 | $13.05 | 40314.2353 | D | |||||
Phantom Stock | 5/8/2003 | A4 | 1601.1629 | (2) | (3) | Common Stock | 1601.1629 | $15.65 | 43024.9068 (5) | D | |||||
Phantom Stock | 5/15/2003 | A4 | 10318.7161 | (2) | (3) | Common Stock | 10318.7161 | $16.7 | 53343.6229 | D | |||||
Phantom Stock | 6/9/2003 | A4 | 638.2596 | (2) | (3) | Common Stock | 638.2596 | $17.99 | 53981.8825 | D | |||||
Phantom Stock | 6/24/2003 | A4 | 3.9882 | (2) | (3) | Common Stock | 3.9882 | $18.61 | 53985.8707 | D | |||||
Phantom Stock | 7/16/2003 | A4 | 598.811 | (2) | (3) | Common Stock | 598.811 | $19.31 | 54584.6817 | D | |||||
Phantom Stock | 8/1/2003 | A4 | 65.3389 | (2) | (3) | Common Stock | 65.3389 | $18.43 | 54747.6207 (6) | D | |||||
Phantom Stock | 8/13/2003 | A4 | 597.4356 | (2) | (3) | Common Stock | 597.4356 | $18.62 | 55345.0563 | D | |||||
Phantom Stock | 9/12/2003 | A4 | 491.3268 | (2) | (3) | Common Stock | 491.3268 | $20.86 | 55836.3831 | D | |||||
Phantom Stock | 10/17/2003 | A4 | 610.0312 | (2) | (3) | Common Stock | 610.0312 | $21.49 | 56446.4143 | D | |||||
Phantom Stock | 10/29/2003 | A4 | 79.8741 | (2) | (3) | Common Stock | 79.8741 | $22.28 | 56608.1475 (7) | D | |||||
Phantom Stock | 11/7/2003 | A4 | 57.7909 | (2) | (3) | Common Stock | 57.7909 | $22.38 | 56665.9384 | D | |||||
Phantom Stock | 11/12/2003 | A4 | 493.3797 | (2) | (3) | Common Stock | 493.3797 | $22.12 | 57159.3181 | D | |||||
Phantom Stock | 12/10/2003 | A4 | 76.8352 | (2) | (3) | Common Stock | 76.8352 | $19.6 | 57236.1533 | D | |||||
Phantom Stock | 12/19/2003 | A4 | 574.8428 | (2) | (3) | Common Stock | 574.8428 | $20.36 | 57810.9961 | D | |||||
Phantom Stock | 1/15/2004 | A4 | 71.792 | (2) | (3) | Common Stock | 71.792 | $21.06 | 57882.7881 | D |
Reporting Owners
|
|||||
Reporting Owner Name / Address |
|
||||
Director | 10% Owner | Officer | Other | ||
O BRIANT STONIE R
100 MISSION RIDGE GOODLETTSVILLE, TN 37072 |
|
|
Executive Vice President |
|
Signatures
|
||
/s/ Susan S. Lanigan, By Power of Attorney | 2/24/2004 | |
** Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |