SEC Form 4
| FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Grocery Outlet Holding Corp. [ GO ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 02/03/2020 | ||||||||||||||||||||||||||
| 4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock | 02/03/2020 | S | 14,935,531 | D | $31.845(1) | 27,426,362 | I | See Footnote(2) | ||
| Common Stock | 02/03/2020 | J(3) | 883,000 | D | $0.00 | 26,543,362 | I | See Footnote(2) | ||
| Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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| Explanation of Responses: |
| 1. This amount represents the $33.00 secondary public offering price per share of the Common Stock of the Issuer less the underwriting discount of $1.155 per share. |
| 2. Reflects securities directly held by H&F Globe Investor LP ("H&F Investor"). The general partner of H&F Investor is H&F Globe Investor GP LLC ("Globe Investor GP"). Hellman & Friedman Capital Partners VII (Parallel), L.P. ("HFCP VII") is the managing member of Globe Investor GP. Hellman & Friedman Investors VII, L.P. ("H&F Investors VII") is the general partner of HFCP VII. H&F Corporate Investors VII, Ltd. ("H&F VII") is the general partner of H&F Investors VII. |
| 3. Represents in-kind distributions of shares of Common Stock previously held by H&F Investor to certain of its direct and indirect partners for the sole purpose of charitable giving. |
| Remarks: |
| By: /s/ Erik D. Ragatz, VP of H&F CORPORATE INVESTORS VII, LTD | 02/05/2020 | |
| By: /s/ Erik D. Ragatz, VP of H&F CORPORATE INVESTORS VII, LTD, GP of HELLMAN & FRIEDMAN INVESTORS VII, L.P. | 02/05/2020 | |
| By: /s/ Erik D. Ragatz, VP of H&F CORPORATE INVESTORS VII, LTD, GP of HELLMAN & FRIEDMAN INVESTORS VII, L.P., GP of HELLMAN & FRIEDMAN CAPITAL PARTNERS VII (PARALLEL), L.P. | 02/05/2020 | |
| By: /s/ Erik D. Ragatz, VP of H&F CORPORATE INVESTORS VII, LTD, GP of HELLMAN & FRIEDMAN INVESTORS VII, L.P., GP of HELLMAN & FRIEDMAN CAPITAL PARTNERS VII (PARALLEL), L.P., managing member of H&F GLOBE INVESTOR GP LLC | 02/05/2020 | |
| By: /s/ Erik D. Ragatz, VP of H&F CORPORATE INVESTORS VII, LTD, GP of HELLMAN & FRIEDMAN INVESTORS VII, L.P., GP of HELLMAN & FRIEDMAN CAPITAL PARTNERS VII (PARALLEL), L.P., managing member of H&F GLOBE INVESTOR GP LLC, GP of H&F GLOBE INVESTOR LP | 02/05/2020 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. | ||