Amended Statement of Changes in Beneficial Ownership (4/a)
October 08 2021 - 6:31PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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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1. Name and Address of Reporting Person
*
Blumenthal Neil Harris |
2. Issuer Name and Ticker or Trading Symbol
Warby Parker Inc.
[
WRBY
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Co-Chief Executive Officer |
(Last)
(First)
(Middle)
C/O WARBY PARKER INC., 233 SPRING STREET, 6TH FLOOR EAST |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/29/2021 |
(Street)
NEW YORK, NY 10013
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
10/1/2021 |
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Class B Common Stock | (1)(2) | | | | | | | (1)(2) | (1)(2) | Class A Common Stock | 2810407.0 | | 2810407 (3) | D | |
Restricted Stock Units | (4) | | | | | | | (5) | (5) | Class A Common Stock | 19241.0 | | 19241 (6) | D | |
Explanation of Responses: |
(1) | The Class B Common Stock is convertible at any time at the option of the holder into the Issuer's Class A Common Stock on a one-to-one basis. The Class B Common Stock will automatically convert intoshares of the Issuer's Class A Common Stock on a one-to-one basis upon the earlier of (i) transfer of Class B common stock to a person or entity that is not in the transferor's permitted ownership group, (ii) October 1, 2031, (iii) with respect to any Class B common stock held by any person or entity in Neil Blumenthal's permitted ownership group, (A) such time as Neil Blumenthal is removed or resigns from theboard of directors, or otherwise ceases to serve as a director, (B) such time as Neil Blumenthal ceases to be either an employee, officer or consultant of the Company or any of its subsidiaries, or (C) the date that is 12 months after the death or disability of Neil Blumenthal, |
(2) | and (iv) with respect to any Class B common stock held by any person or entity in Dave Gilboa's permitted ownership group, (A) such time as Dave Gilboa is removed or resigns from the board of directors, orotherwise ceases to serve as a director, (B) such time as Dave Gilboa ceases to be either an employee, officer or consultant of the Company or any of its subsidiaries, or (C) the date that is 12 months after the death or disability of Dave Gilboa. |
(3) | On October 1, 2021, the reporting person filed a Form 4 (the "Original Form 4") which misstated the number of shares of Class B Common Stock directly owned following the transactions reported therein. Immediately following the transactions reported therein, the Reporting Person directly owned 2,810,407 shares of Class B Common Stock. |
(4) | Each restricted stock unit represents a contingent right to receive one share of the Issuer's Class B Common Stock. |
(5) | The restricted stock units will vest in 48 monthly installments beginning on January 1, 2019 and will expire on May 1, 2026. |
(6) | The Original Form 4 misstated the number of restricted stock units subject to this award following the transactions reported therein, and this amendment is being filed to correct that amount. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Blumenthal Neil Harris C/O WARBY PARKER INC. 233 SPRING STREET, 6TH FLOOR EAST NEW YORK, NY 10013 | X | X | Co-Chief Executive Officer |
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Signatures
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/s/ Hyung Bak, Attorney-in-Fact | | 10/8/2021 |
**Signature of Reporting Person | Date |
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