0001140361-17-039568.txt : 20171025 0001140361-17-039568.hdr.sgml : 20171025 20171025185512 ACCESSION NUMBER: 0001140361-17-039568 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20171025 FILED AS OF DATE: 20171025 DATE AS OF CHANGE: 20171025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GOODMAN MITCHELL CENTRAL INDEX KEY: 0001181070 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38257 FILM NUMBER: 171154152 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: National Vision Holdings, Inc. CENTRAL INDEX KEY: 0001710155 STANDARD INDUSTRIAL CLASSIFICATION: OPHTHALMIC GOODS [3851] IRS NUMBER: 464841717 STATE OF INCORPORATION: DE FISCAL YEAR END: 1230 BUSINESS ADDRESS: STREET 1: 2435 COMMERCE AVENUE STREET 2: BLDG. 2200 CITY: DULUTH STATE: GA ZIP: 30096-4980 BUSINESS PHONE: (770) 822-3600 MAIL ADDRESS: STREET 1: 2435 COMMERCE AVENUE STREET 2: BLDG. 2200 CITY: DULUTH STATE: GA ZIP: 30096-4980 3 1 form3.xml FORM 3 X0206 3 2017-10-25 0 0001710155 National Vision Holdings, Inc. EYE 0001181070 GOODMAN MITCHELL C/O NATIONAL VISION HOLDINGS, INC., 2435 COMMERCE AVENUE, BLDG. 2200 DULUTH GA 30096-4980 true SVP, GC and Secretary Common Stock 101715 D Stock Option (Right to Buy) 4.27 2024-03-13 Common Stock 85440 D Stock Option (Right to Buy) 7.25 2024-03-13 Common Stock 28480 D Stock Option (Right to Buy) 8.23 2024-03-13 Common Stock 28480 D Of these 85,440 stock options, 28,480 are vested and the remaining 56,960 stock options will vest in two equal annual installments on March 13, 2018 and 2019. An additional 213,602 stock options which remain subject to liquidity-event performance-based vesting conditions are not included in the table above. These stock options are fully vested. These stock options are fully vested. Exhibit List: Exhibit 24 - Power of Attorney /s/ Jared Brandman, as Attorney-in-Fact 2017-10-25 EX-24 2 ex24.htm EXHIBIT 24
Exhibit 24
 
Power of Attorney

Know all by these presents that the undersigned does hereby make, constitute and appoint each of Jared Brandman and Ronnie Brown, or any one of them, as a true and lawful attorney-in-fact and agent of the undersigned, with full powers of substitution and revocation, for and in the name, place and stead of the undersigned (in the undersigned's individual capacity), to execute and deliver such forms that the undersigned may be required to file with the U.S. Securities and Exchange Commission as a result of the undersigned's ownership of or transactions in securities of National Vision Holdings, Inc. (i) pursuant to Section 16(a) of the Securities Exchange Act of 1934, as amended, including without limitation, statements on Form 3, Form 4 and Form 5 (including any amendments thereto), and (ii) in connection with any applications for EDGAR access codes or any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the Securities and Exchange Commission, including without limitation an Update Passphrase request. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with regard to the undersigned's ownership of or transactions in securities of National Vision Holdings, Inc., unless earlier revoked in writing. The undersigned acknowledges that Jared Brandman and Ronnie Brown are not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934.
 
     
By:
/s/ Mitchell Goodman
  
       
Mitchell Goodman
  
           
Date:
October 3, 2017