0000899243-19-018001.txt : 20190624 0000899243-19-018001.hdr.sgml : 20190624 20190624185117 ACCESSION NUMBER: 0000899243-19-018001 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: Lindberg Eric J. Jr. CENTRAL INDEX KEY: 0001779740 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38950 FILM NUMBER: 19916455 MAIL ADDRESS: STREET 1: GROCERY OUTLET HOLDING CORP. STREET 2: 56560 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 0001779740 Lindberg Eric J. Jr. C/O GROCERY OUTLET HOLDING CORP. 5650 HOLLIS STREET EMERYVILLE CA 94608 0 1 0 0 Chief Executive Officer Common Stock 2019-06-24 4 P 0 460 22.00 A 460 I By child Common Stock 2019-06-24 4 P 0 460 22.00 A 460 I By spouse Common Stock 2651670 I By Lindberg Revocable Trust Common Stock 701500 I By Lindberg Irrevocable Trust Stock Options (Right to Buy) 22.00 2019-06-19 4 A 0 210450 0.00 A 2029-06-19 Common Stock 210450 210450 D Shares were acquired by Mr. Lindberg's child in a directed share program in connection with Grocery Outlet Holding Corp.'s (the "Issuer") initial public offering. Mr. Lindberg disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. Shares were acquired by Mr. Lindberg's wife in a directed share program in connection with the Issuer's initial public offering. Mr. Lindberg disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. Reflects shares directly held by the Lindberg Revocable Trust u/a/d 2/14/06 of which Mr. Lindberg is a Trustee Reflects shares directly held by the Lindberg Irrevocable Trust u/a/d 5/12/17 of which Mr. Lindberg is a Trustee. 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, as Attorney-in-Fact 2019-06-24