0001710155-21-000041.txt : 20210611 0001710155-21-000041.hdr.sgml : 20210611 20210611164609 ACCESSION NUMBER: 0001710155-21-000041 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210609 FILED AS OF DATE: 20210611 DATE AS OF CHANGE: 20210611 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Johnson Susan S CENTRAL INDEX KEY: 0001616181 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38257 FILM NUMBER: 211011916 MAIL ADDRESS: STREET 1: 303 PEACHTREE STREET, NE CITY: ATLANTA STATE: GA ZIP: 30308 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: 0101 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_162344435288258.xml FORM 4 X0306 4 2021-06-09 0 0001710155 National Vision Holdings, Inc. EYE 0001616181 Johnson Susan S C/O NATIONAL VISION HOLDINGS, INC. 2435 COMMERCE AVENUE, BLDG 2200 DULUTH GA 30096 1 0 0 0 Common Stock 2021-06-09 4 A 0 2061 0 A 4429 D Restricted stock award granted as director compensation, which will vest on the first anniversary of the grant date, subject to continued service through the applicable vesting date. /s/ Jared Brandman, as Attorney-in-Fact 2021-06-11