0000899243-21-010495.txt : 20210308
0000899243-21-010495.hdr.sgml : 20210308
20210308205924
ACCESSION NUMBER: 0000899243-21-010495
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: Jaros Carey F.
CENTRAL INDEX KEY: 0001823561
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38950
FILM NUMBER: 21723812
MAIL ADDRESS:
STREET 1: GROCERY OUTLET HOLDING CORP.
STREET 2: 5650 HOLLIS STREET
CITY: EMERYVILLE
STATE: CA
ZIP: 94608
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
0001823561
Jaros Carey F.
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
3581
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