0001795128-21-000004.txt : 20210309 0001795128-21-000004.hdr.sgml : 20210309 20210309164701 ACCESSION NUMBER: 0001795128-21-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210305 FILED AS OF DATE: 20210309 DATE AS OF CHANGE: 20210309 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: 21726577 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: 0102 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_161532639371372.xml FORM 4 X0306 4 2021-03-05 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 2021-03-05 4 A 0 1917 0 A Common Stock 1917.0 8601 D Stock Option (Right to Buy) 45.66 2021-03-05 4 A 0 3779 0 A 2031-03-05 Common Stock 3779.0 3779 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. The total number of derivative securities beneficially owned by the reporting person is updated to correct an administrative error in the previous Form 4. The option vests in three equal annual installments beginning on the first anniversary of the grant date. /s/ Jared Brandman as Attorney-in-Fact 2021-03-09