0001795128-19-000009.txt : 20191211 0001795128-19-000009.hdr.sgml : 20191211 20191211164204 ACCESSION NUMBER: 0001795128-19-000009 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191209 FILED AS OF DATE: 20191211 DATE AS OF CHANGE: 20191211 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Blackwood Joan CENTRAL INDEX KEY: 0001795128 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38257 FILM NUMBER: 191280168 MAIL ADDRESS: STREET 1: C/O NATIONAL VISION HOLDINGS, INC. STREET 2: 2435 COMMERCE AVE., BUILDING 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: 1228 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 4 1 wf-form4_157610050753786.xml FORM 4 X0306 4 2019-12-09 0 0001710155 National Vision Holdings, Inc. EYE 0001795128 Blackwood Joan C/O NATIONAL VISION HOLDINGS, INC. 2435 COMMERCE AVENUE, BLDG. 2200 DULUTH GA 30096-4980 0 1 0 0 SVP, Chief Marketing Officer Restricted Stock Units 2019-12-09 4 A 0 8230 0 A Common Stock 8230.0 8230 D Each restricted stock unit represents a contingent right to receive one share of NVHI common stock. The restricted stock units will vest in three equal annual installments beginning on the first anniversary of the grant date. /s/ Jared Brandman as Attorney-in-Fact 2019-12-11