0001804913-24-000004.txt : 20240307 0001804913-24-000004.hdr.sgml : 20240307 20240307161902 ACCESSION NUMBER: 0001804913-24-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240305 FILED AS OF DATE: 20240307 DATE AS OF CHANGE: 20240307 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Acharya Ravi CENTRAL INDEX KEY: 0001804913 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38257 FILM NUMBER: 24730399 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] ORGANIZATION NAME: 08 Industrial Applications and Services IRS NUMBER: 464841717 STATE OF INCORPORATION: DE FISCAL YEAR END: 1230 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 wk-form4_1709846333.xml FORM 4 X0508 4 2024-03-05 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 0 Common Stock 2024-03-05 4 M 0 639 A 14198 D Common Stock 2024-03-05 4 F 0 191 22.62 D 14007 D Common Stock 2024-03-05 4 M 0 2556 0 A 16563 D Common Stock 2024-03-05 4 F 0 763 22.62 D 15800 D Restricted Stock Units 2024-03-05 4 M 0 639 0 D Common Stock 639 8012 D Restricted stock units convert into common stock on a one-for-one basis. Reflects payment of tax liability by withholding securities incident to vesting of restricted stock units. Reflects the issuance of shares upon vesting of performance stock units granted to the reporting person on March 5, 2021. Reflects payment of tax liability by withholding securities incident to vesting of performance stock units. On March 5, 2021, the reporting person was granted 1,917 restricted stock units, which vest in three equal installments on each anniversary of the grant date. /s/ Jared Brandman, Attorney-in-Fact 2024-03-07