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