0001261163-18-000016.txt : 20181121 0001261163-18-000016.hdr.sgml : 20181121 20181121162218 ACCESSION NUMBER: 0001261163-18-000016 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181119 FILED AS OF DATE: 20181121 DATE AS OF CHANGE: 20181121 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: 181198439 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_154283531748114.xml FORM 4 X0306 4 2018-11-19 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 Stock Option (Right to Buy) 4.27 2018-11-19 4 A 0 37075 4.27 A 2024-03-13 Common Stock 37075.0 100830 D On March 13, 2014, the reporting person was granted stock options, subject to time-based and performance-based vesting. On November 19, 2018, a liquidity event with respect to such performance-based stock options occurred as a result of sales by the Issuer's sponsor stockholders and 37,075 stock options which had previously not been reported were deemed earned. Of these 100,830 stock options, 78,860 are vested and the remaining 21,970 stock options will vest on March 13, 2019. An additional 61,792 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 2018-11-21