0001771515-23-000063.txt : 20230621
0001771515-23-000063.hdr.sgml : 20230621
20230621195849
ACCESSION NUMBER: 0001771515-23-000063
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230620
FILED AS OF DATE: 20230621
DATE AS OF CHANGE: 20230621
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bortner Andrea Renee
CENTRAL INDEX KEY: 0001808260
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38950
FILM NUMBER: 231031251
MAIL ADDRESS:
STREET 1: C/O 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: 1230
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
wk-form4_1687391917.xml
FORM 4
X0407
4
2023-06-20
0
0001771515
Grocery Outlet Holding Corp.
GO
0001808260
Bortner Andrea Renee
C/O GROCERY OUTLET HOLDING CORP.
5650 HOLLIS STREET
EMERYVILLE
CA
94608
0
1
0
0
Chief Human Resources Officer
0
Common Stock
2023-06-20
4
F
0
2689
28.72
D
46286
D
These shares were withheld by the Issuer to satisfy the reporting person's tax withholding obligation upon vesting of RSUs previously granted.
/s/ Lauri Fischer, Lauri Fischer, attorney-in-fact
2023-06-21