0001771515-21-000013.txt : 20210308 0001771515-21-000013.hdr.sgml : 20210308 20210308202550 ACCESSION NUMBER: 0001771515-21-000013 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210304 FILED AS OF DATE: 20210308 DATE AS OF CHANGE: 20210308 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HABEN MARY KAY CENTRAL INDEX KEY: 0001190910 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38950 FILM NUMBER: 21723726 MAIL ADDRESS: STREET 1: C/O EQUITY RESIDENTIAL STREET 2: TWO NORTH RIVERSIDE PLAZA, SUITE 400 CITY: CHICAGO STATE: IL ZIP: 60606 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Grocery Outlet Holding Corp. CENTRAL INDEX KEY: 0001771515 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-GROCERY STORES [5411] IRS NUMBER: 471874201 STATE OF INCORPORATION: DE FISCAL YEAR END: 0102 BUSINESS ADDRESS: STREET 1: 5650 HOLLIS STREET CITY: EMERYVILLE STATE: CA ZIP: 94608 BUSINESS PHONE: (510) 845-1999 MAIL ADDRESS: STREET 1: 5650 HOLLIS STREET CITY: EMERYVILLE STATE: CA ZIP: 94608 4 1 wf-form4_161525313573553.xml FORM 4 X0306 4 2021-03-04 0 0001771515 Grocery Outlet Holding Corp. GO 0001190910 HABEN MARY KAY C/O GROCERY OUTLET HOLDING CORP. 5650 HOLLIS STREET EMERYVILLE CA 94608 1 0 0 0 Common Stock 2021-03-04 4 A 0 2821 0 A 5882 D Represents a grant of 2,821 deferred stock units that will vest in full on March 1, 2022, subject to the continued service of the reporting person through such vesting date, and, if vested, will be settled in shares of Common Stock upon the reporting person's termination of service from the board of directors. /s/ Pamela B. Burke, as Attorney-in-Fact 2021-03-08