0001261163-18-000014.txt : 20180926 0001261163-18-000014.hdr.sgml : 20180926 20180926174535 ACCESSION NUMBER: 0001261163-18-000014 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180924 FILED AS OF DATE: 20180926 DATE AS OF CHANGE: 20180926 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: 181088765 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_153799825147832.xml FORM 4 X0306 4 2018-09-24 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 2018-09-24 4 M 0 36771 4.27 A 98864 D Common Stock 2018-09-24 4 S 0 36771 42.40 D 62093 D Stock Option (Right to Buy) 4.27 2018-09-24 4 M 0 36771 4.27 D 2024-03-13 Common Stock 36771.0 63755 D The sale reported on this Form 4 was effected pursuant to a Rule 10b5-1 trading plan established by the reporting person on August 23, 2018 Of these 100,526 stock options, 78,556 are vested and the remaining 21,970 stock options will vest on March 13, 2019. An additional 98,867 stock options which remain subject to liquidity-event performance-based vesting conditions are not included in the table above. /s/ Jared Brandman, as Attorney-in-Fact 2018-09-26