0001261163-19-000004.txt : 20190530 0001261163-19-000004.hdr.sgml : 20190530 20190530163020 ACCESSION NUMBER: 0001261163-19-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190528 FILED AS OF DATE: 20190530 DATE AS OF CHANGE: 20190530 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: 19866917 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: 1229 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_155924820448126.xml FORM 4 X0306 4 2019-05-28 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 2019-05-28 4 M 0 29980 4.27 A 92073 D Common Stock 2019-05-28 4 S 0 29980 29.017 D 62093 D Common Stock 2019-05-29 4 M 0 20764 4.27 A 82857 D Common Stock 2019-05-28 4 S 0 20764 28 D 62093 D Stock Option (Right to Buy) 4.27 2019-05-28 4 M 0 29980 0 D 2024-03-13 Common Stock 29980.0 70850 D Stock Option (Right to Buy) 4.27 2019-05-29 4 M 0 20764 0 D 2024-03-13 Common Stock 20764.0 50086 D Price represents the weighted average sales price. The shares were sold pursuant to a single order in multiple transactions as prices ranging from $29.00 to $29.09. Upon request by the SEC staff, the issuer or a security holder of the issuer, the reporting person will provide full information regarding the number of shares sold at each separate price. Of these 70,850 stock options, all are vested. An additional 61,792 stock options which remain subject to liquidity-event performance-based vesting conditions are not included in the table above. Of these 50,086 stock options, all are vested. 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 2019-05-30