0000899243-19-018000.txt : 20190624 0000899243-19-018000.hdr.sgml : 20190624 20190624185056 ACCESSION NUMBER: 0000899243-19-018000 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190619 FILED AS OF DATE: 20190624 DATE AS OF CHANGE: 20190624 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McMahon Thomas H. CENTRAL INDEX KEY: 0001779767 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38950 FILM NUMBER: 19916453 MAIL ADDRESS: STREET 1: GROCERY OUTLET HOLDING CORP. STREET 2: 5650 HOLLIS STREET CITY: EMERYVILLE STATE: CA ZIP: 94608 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: 1231 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 doc4.xml FORM 4 SUBMISSION X0306 4 2019-06-19 0 0001771515 Grocery Outlet Holding Corp. GO 0001779767 McMahon Thomas H. C/O GROCERY OUTLET HOLDING CORP. 5650 HOLLIS STREET EMERYVILLE CA 94608 0 1 0 0 EVP, Sales & Merchandising Non-voting common stock 2019-06-24 4 D 0 91195 D 0 D Common Stock 2019-06-24 4 A 0 91195 A 91195 D Stock Options (Right to Buy) 22.00 2019-06-19 4 A 0 63135 0.00 A 2029-06-19 Common Stock 63135 63135 D Upon the completion of the initial public offering of Grocery Outlet Holding Corp. (the "Issuer") on June 24, 2019, all shares of the Issuer's non-voting common stock automatically converted into shares of the Issuer's voting common stock on a one-for-one basis. Represents stock options previously granted to the reporting person on June 19, 2019. These stock options were already reflected on the reporting person's previously filed Form 3. These stock options vest on June 19, 2023. /s/ Pamela B. Burke, Pamela B. Burke, as Attorney-in-Fact 2019-06-24