0001104659-22-022478.txt : 20220214
0001104659-22-022478.hdr.sgml : 20220214
20220214150505
ACCESSION NUMBER: 0001104659-22-022478
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211231
FILED AS OF DATE: 20220214
DATE AS OF CHANGE: 20220214
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gilboa David Abraham
CENTRAL INDEX KEY: 0001883353
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40825
FILM NUMBER: 22630154
MAIL ADDRESS:
STREET 1: C/O WARBY PARKER INC.
STREET 2: 233 SPRING STREET, 6TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10013
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Warby Parker Inc.
CENTRAL INDEX KEY: 0001504776
STANDARD INDUSTRIAL CLASSIFICATION: OPHTHALMIC GOODS [3851]
IRS NUMBER: 800423634
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 233 SPRING STREET
STREET 2: 6TH FLOOR EAST
CITY: NEW YORK
STATE: NY
ZIP: 10013
BUSINESS PHONE: (646) 847-7215
MAIL ADDRESS:
STREET 1: 233 SPRING STREET
STREET 2: 6TH FLOOR EAST
CITY: NEW YORK
STATE: NY
ZIP: 10013
FORMER COMPANY:
FORMER CONFORMED NAME: JAND, Inc.
DATE OF NAME CHANGE: 20101102
5
1
tm226442-1_5seq1.xml
OWNERSHIP DOCUMENT
X0306
5
2021-12-31
0
0
0
0001504776
Warby Parker Inc.
WRBY
0001883353
Gilboa David Abraham
C/O WARBY PARKER INC.
233 SPRING STREET, 6TH FLOOR EAST
NEW YORK
NY
10013
1
1
0
0
Co-Chief Executive Officer
Class B Common Stock
2021-12-14
5
G
0
75000
0
D
Class A Common Stock
75000
2056770
I
By David A. Gilboa 2012 Family Trust
Class B Common Stock
Class A Common Stock
0
6555796
D
The Class B Common Stock is convertible at any time at the option of the holder into the Issuer's Class A Common Stock on a one-to-one basis. The Class B Common Stock will automatically convert into shares of the Issuer's Class A Common Stock on a one-to-one basis upon the earlier of (i) transfer of Class B common stock to a person or entity that is not in the transferor's permitted ownership group, (ii) October 1, 2031, (iii) with respect to any Class B common stock held by any person or entity in Neil Blumenthal's permitted ownership group, (A) such time as Neil Blumenthal is removed or resigns from the board of directors, or otherwise ceases to serve as a director, (B) such time as Neil Blumenthal ceases to be either an employee, officer or consultant of the Company or any of its subsidiaries, or (C) the date that is 12 months after the death or disability of Neil Blumenthal,
and (iv) with respect to any Class B common stock held by any person or entity in Dave Gilboa's permitted ownership group, (A) such time as Dave Gilboa is removed or resigns from the board of directors, or otherwise ceases to serve as a director, (B) such time as Dave Gilboa ceases to be either an employee, officer or consultant of the Company or any of its subsidiaries, or (C) the date that is 12 months after the death or disability of Dave Gilboa.
/s/ Hyung Bak, Attorney-in-Fact
2022-02-14