FORM 5
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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 |
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1. Name and Address of Reporting Person
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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 |
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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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) |
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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) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||||
Phantom Stock | 2/3/2003 | A4 | 0.3239 | (2) | (3) | Common Stock | 0.3239 | $11.31 | 4179.7915 | D | |||||
Phantom Stock | 3/18/2003 | A4 | 9.9034 | (2) | (3) | Common Stock | 9.9034 | $12.52 | 4189.6949 | D | |||||
Phantom Stock | 4/9/2003 | A4 | 1.023 | (2) | (3) | Common Stock | 1.023 | $13.05 | 4192.743 (4) | D | |||||
Phantom Stock | 5/8/2003 | A4 | 1285.8658 | (2) | (3) | Common Stock | 1285.8658 | $15.65 | 5482.127 (5) | D | |||||
Phantom Stock | 5/15/2003 | A4 | 23.4338 | (2) | (3) | Common Stock | 23.4338 | $16.7 | 5505.5608 | D | |||||
Phantom Stock | 6/9/2003 | A4 | 0.1779 | (2) | (3) | Common Stock | 0.1779 | $17.99 | 5505.7387 | D | |||||
Phantom Stock | 6/24/2003 | A4 | 0.0011 | (2) | (3) | Common Stock | 0.0011 | $18.61 | 5505.7398 | D | |||||
Phantom Stock | 7/16/2003 | A4 | 0.0254 | (2) | (3) | Common Stock | 0.0254 | $19.31 | 5505.7652 | D | |||||
Phantom Stock | 8/13/2003 | A4 | 2.9554 | (2) | (3) | Common Stock | 2.9554 | $18.62 | 5515.5423 (6) | D | |||||
Phantom Stock | 9/12/2003 | A4 | 5.4957 | (2) | (3) | Common Stock | 5.4957 | $20.86 | 5521.038 | D | |||||
Phantom Stock | 10/17/2003 | A4 | 1.9991 | (2) | (3) | Common Stock | 1.9991 | $21.49 | 5523.0371 | D | |||||
Phantom Stock | 11/7/2003 | A4 | 0.3892 | (2) | (3) | Common Stock | 0.3892 | $22.38 | 5527.4473 (7) | D | |||||
Phantom Stock | 11/12/2003 | A4 | 3.3219 | (2) | (3) | Common Stock | 3.3219 | $22.12 | 5530.7692 | D | |||||
Phantom Stock | 12/19/2003 | A4 | 1.3438 | (2) | (3) | Common Stock | 1.3438 | $20.36 | 5532.113 | D |
Reporting Owners
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Reporting Owner Name / Address |
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Director | 10% Owner | Officer | Other | ||
HARTSHORN TOM J
100 MISSION RIDGE GOODLETTSVILLE, TN 37072 |
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Executive Vice President |
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Signatures
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/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. |