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