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