0001804913-21-000004.txt : 20210318 0001804913-21-000004.hdr.sgml : 20210318 20210318163443 ACCESSION NUMBER: 0001804913-21-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210316 FILED AS OF DATE: 20210318 DATE AS OF CHANGE: 20210318 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Acharya Ravi CENTRAL INDEX KEY: 0001804913 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38257 FILM NUMBER: 21754806 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_161609966545988.xml FORM 4 X0306 4 2021-03-16 0 0001710155 National Vision Holdings, Inc. EYE 0001804913 Acharya Ravi C/O NATIONAL VISION HOLDINGS, INC. 2435 COMMERCE AVENUE, BLDG. 2200 DULUTH GA 30096 0 1 0 0 SVP, Chief Technology Officer Common Stock 2021-03-16 4 M 0 896 0 A 896 D Common Stock 2021-03-16 4 F 0 270 45.65 D 626 D Restricted Stock Units 2021-03-16 4 M 0 896 0 D Common Stock 896.0 3710 D Each restricted stock unit represents a contingent right to receive one share of NVHI common stock. On March 16, 2020, the reporting person was granted 2,689 restricted stock units, vesting in three equal annual installments beginning on the first anniversary of the grant date. /s/ Jared Brandman, as Attorney-in-Fact 2021-03-18