0001181070-18-000012.txt : 20181116 0001181070-18-000012.hdr.sgml : 20181116 20181116161226 ACCESSION NUMBER: 0001181070-18-000012 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181114 FILED AS OF DATE: 20181116 DATE AS OF CHANGE: 20181116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GOODMAN MITCHELL CENTRAL INDEX KEY: 0001181070 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38257 FILM NUMBER: 181189971 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 4 1 wf-form4_154240272955503.xml FORM 4 X0306 4 2018-11-14 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 0 1 0 0 SVP, GC and Secretary Common Stock 2018-11-14 4 M 0 85440 4.27 A 139380 D Common Stock 2018-11-14 4 M 0 9136 7.25 A 148516 D Stock Option (Right to Buy) 4.27 2018-11-14 4 M 0 85440 4.27 D 2024-03-13 Common Stock 85440.0 28480 D Stock Option (Right to Buy) 7.25 2018-11-14 4 M 0 9136 7.25 D 2024-03-13 Common Stock 9136.0 3650 D Represents an exercise of stock options in connection with the Reporting Person's sale of shares of common stock received upon exercise in a secondary offering that is scheduled to be completed on November 19, 2018. The remaining 28,480 stock options will vest on March 13, 2019. An additional 128,162 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. /s/ Jared Brandman, as Attorney-in-Fact 2018-11-16