3 1 snjgrat123002.htm DocXchange Conversion Stat

FORM 3

U.S. SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549


INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES


Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public

Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

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(Print or Type Responses)

1. Name and Address of Reporting Person*





Stephen N. Joffe Grantor Retained Annuity Trust Two, dated December 31, 2002

2.  Date of Event Requiring Statement for
(Month/Day/Year)

12/30/2002

4. Issuer Name and Ticker or Trading Symbol


LCA-Vision Inc./LCAV

(Last)                     (First)                    (Middle)






8750 Red Fox Lane

3.  I.R.S. Identification Number of Reporting
Person, if an entity (voluntary)



5.  Relationship of Reporting Person(s) to Issuer

(Check all applicable)


      

 Director

   X

 10% Owner

      

 Officer (give

      

 Other (specify

title below)

below)

6. 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

(Street)

 

Cincinnati

OH

45243

 

(City)

(State)

(Zip)


Table I - Non-Derivative Securities Beneficially Owned

1.  Title of Security
(Instr. 4)

2.  Amount of Securities
Beneficially Owned
(Instr. 4)

3.  Ownership Form:
Direct (D) of
Indirect (I)
(Instr. 5)

4.  Nature of Indirect Beneficial Ownership
(Instr. 5)

Common Stock

1,663,257

D

 
    
    
    
    
    
    
    
    

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.


Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)

 

1.  Title of Derivative Security
(Instr. 4)

2.   Date Exercisable
and Expiration Date (Month/Day/Year)

3.   Title and Amount of Securities
Underlying Derivative Security
(Instr. 4)

4. Conversion
or Exercise
Price of
Derivative
Security

5.  Ownership
Form of
Derivative
Securities:
Direct (D) or
Indirect (I)
(Instr. 5)

6.  Nature of Indirect
Beneficial Ownership
(Instr. 5)

Date Exercisable

Expiration Date


Title

Amount or Number of Shares

        
        
        
        
        
        
        
        
        

Explanation of Responses:






*If the form is filed by more than one reporting person, see Instruction 5(b)(v).


**Intentional misstatements or omissions of facts constitute Federal Criminal Violations.

/s/Charles F. Hertlein, Jr.

2/7/03

See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

**Signature of Reporting Person

Date

Stephen N. Joffe, Trustee

Note: File three copies of this Form, one of which must be manually signed.  If space is insufficient,

of Stephen N. Joffe Grantor

See Instruction 6 for procedure.

Retained Annuity Trust Two, dated

December 31, 2002

by Charles F. Hertlein, Jr.,

Attorney-in-fact