0000899243-21-010491.txt : 20210308 0000899243-21-010491.hdr.sgml : 20210308 20210308205455 ACCESSION NUMBER: 0000899243-21-010491 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210304 FILED AS OF DATE: 20210308 DATE AS OF CHANGE: 20210308 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MEJIA MARIA FERNANDA CENTRAL INDEX KEY: 0001673529 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38950 FILM NUMBER: 21723800 MAIL ADDRESS: STREET 1: ONE KELLOGG SQUARE STREET 2: PO BOX 3599 CITY: BATTLE CREEK STATE: MI ZIP: 49016-3599 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Grocery Outlet Holding Corp. CENTRAL INDEX KEY: 0001771515 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-GROCERY STORES [5411] IRS NUMBER: 471874201 STATE OF INCORPORATION: DE FISCAL YEAR END: 0102 BUSINESS ADDRESS: STREET 1: 5650 HOLLIS STREET CITY: EMERYVILLE STATE: CA ZIP: 94608 BUSINESS PHONE: (510) 845-1999 MAIL ADDRESS: STREET 1: 5650 HOLLIS STREET CITY: EMERYVILLE STATE: CA ZIP: 94608 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-03-04 0 0001771515 Grocery Outlet Holding Corp. GO 0001673529 MEJIA MARIA FERNANDA C/O GROCERY OUTLET HOLDING CORP. 5650 HOLLIS STREET EMERYVILLE CA 94608 1 0 0 0 Common Stock 2021-03-04 4 A 0 2821 0.00 A 2821 D Represents 2,821 restricted stock units ("RSUs") granted to the reporting person which are scheduled to vest on March 1, 2022, subject to the continued service of the reporting person through such vesting date. /s/ Pamela B. Burke, Pamela B. Burke, as Attorney-in-Fact 2021-03-08