0001140361-17-039578.txt : 20171025 0001140361-17-039578.hdr.sgml : 20171025 20171025191202 ACCESSION NUMBER: 0001140361-17-039578 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20171025 FILED AS OF DATE: 20171025 DATE AS OF CHANGE: 20171025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McAllister Raymond J. CENTRAL INDEX KEY: 0001719311 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38257 FILM NUMBER: 171154175 MAIL ADDRESS: STREET 1: C/O NATIONAL VISION HOLDINGS, INC. STREET 2: 2435 COMMERCE AVENUE, BLDG. 2200 CITY: DULUTH STATE: GA ZIP: 30096 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: National Vision Holdings, Inc. CENTRAL INDEX KEY: 0001710155 STANDARD INDUSTRIAL CLASSIFICATION: OPHTHALMIC GOODS [3851] IRS NUMBER: 464841717 STATE OF INCORPORATION: DE FISCAL YEAR END: 1230 BUSINESS ADDRESS: STREET 1: 2435 COMMERCE AVENUE STREET 2: BLDG. 2200 CITY: DULUTH STATE: GA ZIP: 30096-4980 BUSINESS PHONE: (770) 822-3600 MAIL ADDRESS: STREET 1: 2435 COMMERCE AVENUE STREET 2: BLDG. 2200 CITY: DULUTH STATE: GA ZIP: 30096-4980 3 1 form3.xml FORM 3 X0206 3 2017-10-25 0 0001710155 National Vision Holdings, Inc. EYE 0001719311 McAllister Raymond J. C/O NATIONAL VISION HOLDINGS, INC. 2435 COMMERCE AVENUE, BLDG. 2200 DULUTH GA 30096-4980 true Chief Operating Officer Common Stock 63572 D Stock Option (Right to Buy) 15.74 2027-08-14 Common Stock 144927 D These stock options will vest in five equal annual installments beginning on August 14, 2018. An additional 217,390 stock options which remain subject to liquidity-event performance-based vesting conditions are not included in the table above. Exhibit List: Exhibit 24 - Power of Attorney /s/ Jared Brandman, as Attorney-in-Fact 2017-10-25 EX-24 2 ex24.htm EXHIBIT 24
Exhibit 24

Power of Attorney

Know all by these presents that the undersigned does hereby make, constitute and appoint each of Mitchell Goodman, Jared Brandman and Ronnie Brown, or any one of them, as a true and lawful attorney-in-fact and agent of the undersigned, with full powers of substitution and revocation, for and in the name, place and stead of the undersigned (in the undersigned's individual capacity), to execute and deliver such forms that the undersigned may be required to file with the U.S. Securities and Exchange Commission as a result of the undersigned's ownership of or transactions in securities of National Vision Holdings, Inc. (i) pursuant to Section 16(a) of the Securities Exchange Act of 1934, as amended, including without limitation, statements on Form 3, Form 4 and Form 5 (including any amendments thereto), and (ii) in connection with any applications for EDGAR access codes or any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the Securities and Exchange Commission, including without limitation the Form ID. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with regard to the undersigned's ownership of or transactions in securities of National Vision Holdings, Inc., unless earlier revoked in writing. The undersigned acknowledges that Mitchell Goodman, Jared Brandman and Ronnie Brown are not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934.

    By:
 /s/ Raymond J. McAllister
  
     
Raymond J. McAllister
  
         
Date:
October 3, 2017