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