FORM 3 |
UNITED STATES 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 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/01/2004 |
3. Issuer Name and Ticker or Trading Symbol
VALUEVISION MEDIA INC [ VVTV ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
No Holdings | 0 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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: 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 | ||||
Common Stock Option (right to buy) | (1) | (2) | Common Stock | 5,000 | $24.75 | D | |
Common Stock Option (right to buy) | (3) | (2) | Common Stock | 2,500 | $14.375 | D | |
Common Stock Option (right to buy) | 03/14/2001 | 03/14/2006 | Common Stock | 239 | $11.438 | D | |
Common Stock Option (right to buy) | (4) | (2) | Common Stock | 3,500 | $20.55 | D | |
Common Stock Option (right to buy) | (5) | (2) | Common Stock | 5,000 | $19.899 | D | |
Common Stock Option (right to buy) | (6) | (2) | Common Stock | 4,590 | $14.77 | D | |
Common Stock Option (right to buy) | 05/09/2004 | 05/09/2009 | Common Stock | 2,800 | $12.35 | D | |
Common Stock Option (right to buy) | (7) | (2) | Common Stock | 25,000 | $15.73 | D | |
Common Stock Option (right to buy) | 12/01/2004 | 07/01/2014 | Common Stock | 4,950 | $13.02 | D | |
Common Stock Option (right to buy) | (7) | 08/12/2014 | Common Stock | 25,000 | $10.54 | D |
Explanation of Responses: |
1. Option vests as to 1,666 shares on the Date of Grant and 1,667 shares on each of the first and second anniversary of the Date of Grant. |
2. Each of the granted stock options shall expire five (5) years after the right to purchase the Shares became effective. |
3. Option vests as 1,250 shares on each of the first and second anniversary of the Date of Grant. |
4. Option vests as to 1,166 shares on the first anniversary of the Date of Grant and 1,167 shares on each of the second and third anniversary of the Date of Grant. |
5. Option vests as to 1,666 shares on the first anniversary of the Date of Grant and 1,667 shares on each of the second and third anniversary of the Date of Grant. |
6. Option vests as to 1,530 shares on each of the first, second and third anniversary of the Date of Grant. |
7. Option vests as to 8,333 shares on each of the first and second anniversary of the Date of Grant and 8,334 shares on the third anniversary of the Date of Grant. |
Remarks: |
/s/Nathan E. Fagre, attorney-in-fact | 11/10/2004 | |
** 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 5 (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 Number. |