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