0001104659-21-133830.txt : 20211103 0001104659-21-133830.hdr.sgml : 20211103 20211103184723 ACCESSION NUMBER: 0001104659-21-133830 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211102 FILED AS OF DATE: 20211103 DATE AS OF CHANGE: 20211103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hackman Gregory V. CENTRAL INDEX KEY: 0001633114 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36711 FILM NUMBER: 211377113 MAIL ADDRESS: STREET 1: 15776 LAGUNA CANYON ROAD CITY: IRVINE STATE: CA ZIP: 92618 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Boot Barn Holdings, Inc. CENTRAL INDEX KEY: 0001610250 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-SHOE STORES [5661] IRS NUMBER: 900776290 STATE OF INCORPORATION: DE FISCAL YEAR END: 0326 BUSINESS ADDRESS: STREET 1: 15345 BARRANCA PARKWAY CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: 949-453-4400 MAIL ADDRESS: STREET 1: 15345 BARRANCA PARKWAY CITY: IRVINE STATE: CA ZIP: 92618 4 1 tm2131623-3_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-11-02 0 0001610250 Boot Barn Holdings, Inc. BOOT 0001633114 Hackman Gregory V. C/O BOOT BARN HOLDINGS, INC. 15345 BARRANCA PKWY IRVINE CA 92618 0 1 0 0 EVP, COO Common Stock 2021-11-02 5 G 0 E 128 0.00 D 29185 D Common Stock 17932 D Donation to a charitable organization. Consists of the number of shares of common stock held by the reporting person as of November 02, 2021, but excluding any shares of common stock subject to further vesting conditions. See Note 3 below. Consists of the total number of shares of common stock underlying restricted stock units held by the reporting person as of November 02, 2021, that remain subject to time-based vesting. /s/ Gregory V. Hackman 2021-11-03