0001261163-18-000006.txt : 20180727
0001261163-18-000006.hdr.sgml : 20180727
20180727162601
ACCESSION NUMBER: 0001261163-18-000006
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180725
FILED AS OF DATE: 20180727
DATE AS OF CHANGE: 20180727
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BUSBEE JEFF
CENTRAL INDEX KEY: 0001261163
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38257
FILM NUMBER: 18975079
MAIL ADDRESS:
STREET 1: 296 GRAYSON HIGHWAY
CITY: LAWRENCEVILLE
STATE: GA
ZIP: 30048
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_153272314490586.xml
FORM 4
X0306
4
2018-07-25
0
0001710155
National Vision Holdings, Inc.
EYE
0001261163
BUSBEE JEFF
C/O NATIONAL VISION HOLDINGS, INC.,
2435 COMMERCE AVENUE, BLDG. 2200
DULUTH
GA
30096-4980
0
1
0
0
SVP, Chief HR Officer
Common Stock
2018-07-25
4
M
0
24514
4.27
A
90357
D
Common Stock
2018-07-25
4
M
0
16345
7.25
A
106702
D
Stock Option (Right to Buy)
4.27
2018-07-25
4
M
0
24514
0
D
2024-03-13
Common Stock
24514.0
41397
D
Stock Option (Right to Buy)
7.25
2018-07-25
4
M
0
16345
0
D
2024-03-13
Common Stock
16345.0
0
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 July 30, 2018.
Of this stock option award, 43,941 are vested and the remaining 21,970 stock options will vest on March 13, 2019. An additional 164,778 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
2018-07-27