0001771515-23-000069.txt : 20230622 0001771515-23-000069.hdr.sgml : 20230622 20230622194318 ACCESSION NUMBER: 0001771515-23-000069 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230621 FILED AS OF DATE: 20230622 DATE AS OF CHANGE: 20230622 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HABEN MARY KAY CENTRAL INDEX KEY: 0001190910 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38950 FILM NUMBER: 231034609 MAIL ADDRESS: STREET 1: C/O EQUITY RESIDENTIAL STREET 2: TWO NORTH RIVERSIDE PLAZA, SUITE 400 CITY: CHICAGO STATE: IL ZIP: 60606 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: 1230 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 wk-form4_1687477389.xml FORM 4 X0407 4 2023-06-21 0 0001771515 Grocery Outlet Holding Corp. GO 0001190910 HABEN MARY KAY C/O GROCERY OUTLET HOLDING CORP. 5650 HOLLIS STREET EMERYVILLE CA 94608 1 0 0 0 0 Common Stock 2023-06-21 4 A 0 5837 0 A 15872 D Represents 5,837 deferred stock units ("DSUs") granted to the reporting person which are scheduled to vest on the earlier of (i) the date of the next annual meeting of stockholders following the date of grant; or (ii) June 20, 2024, subject to the continued service of the reporting person through such vesting date, and, if vested, will be settled in shares of Common Stock upon the reporting person's termination of service from the board of directors.. The DSUs represent the annual equity retainer under the Issuer's non-employee director compensation policy, including (i) a full annual equity award and (ii) a one-time pro rata annual equity award due to a change in 2023 from the historical grant date in early March to the annual meeting date. /s/ Lauri Fischer, Lauri Fischer Attorney-in-Fact 2023-06-22