0001804913-23-000002.txt : 20230106 0001804913-23-000002.hdr.sgml : 20230106 20230106163043 ACCESSION NUMBER: 0001804913-23-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230104 FILED AS OF DATE: 20230106 DATE AS OF CHANGE: 20230106 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: 23515465 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: 1231 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_167304062752286.xml FORM 4 X0306 4 2023-01-04 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 2023-01-04 4 S 0 832 40 D 832 D Common Stock 2023-01-04 4 M 0 3613 23.25 A 4445 D Common Stock 2023-01-04 4 F 0 3051 40 D 1394 D Common Stock 2023-01-04 4 S 0 562 40 D 832 D Common Stock 2023-01-05 4 M 0 562 23.25 A 1394 D Stock Option (Right to Buy) 23.25 2023-01-04 4 M 0 3613 0 D 2030-03-16 Common Stock 3613.0 2650 D Stock Option (Right to Buy) 23.25 2023-01-05 4 M 0 562 0 D 2030-03-16 Common Stock 562.0 2088 D All the transactions reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan established by the reporting person on December 2, 2022. Represents shares sold to cover the exercise price and tax for 4,175 options exercised via a cashless hold. Of that total exercise, 3,613 options were exercised on January 4, 2023 and the remaining 562 options were exercised on January 5, 2023 and are reflected on this form. The 3,613 stock options are all fully vested from a grant of 6,263 time based stock options, which vest in three equal installments on March 16, 2021, March 16, 2022 and on March 16, 2023. The 562 stock options are all fully vested from a grant of 6,263 time based stock options, which vest in three equal installments on March 16, 2021, March 16, 2022 and on March 16, 2023. /s/ Jared Brandman, as Attorney-in-Fact 2023-01-06