Statement of Ownership (sc 13g)
February 14 2022 - 3:02PM
Edgar (US Regulatory)
Securities and Exchange Commission
Washington, D.C. 20549
Schedule 13G
(Rule 13d-102)
Information to be Included in Statements Filed
Pursuant
to § 240.13d-1(b), (c) and (d) and Amendments
Thereto Filed
Pursuant to § 240.13d-2
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(Amendment No. )*
Warby Parker Inc.
(Name of Issuer)
Class A Common Stock
(Title of Class of Securities)
93403J106
(CUSIP Number)
December 31, 2021
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which
this Schedule is filed:
¨ Rule
13d-1(b)
¨
Rule 13d-1(c)
x Rule
13d-1(d)
* The remainder of this cover page shall be filled out for a reporting
person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing
information which would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall
not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise
subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
1
|
Names of Reporting Persons
David A.
Gilboa
|
2
|
Check the Appropriate Box if a Member of a Group
|
(a) ¨
|
|
|
(b) ¨
|
3
|
SEC Use Only
|
4
|
Citizenship or Place of Organization
United
States
|
Number of Shares
Beneficially Owned
by Each Reporting
Person With
|
5
|
Sole Voting Power
7,278,045
|
6
|
Shared Voting Power
2,056,770
|
7
|
Sole Dispositive Power
7,278,045
|
8
|
Shared Dispositive Power
2,056,770
|
9
|
Aggregate
Amount Beneficially Owned by Each Reporting Person
9,334,815
|
10
|
Check if the Aggregate Amount in Row (9) Excludes Certain Shares
Not Applicable
|
11
|
Percent of Class Represented by Amount in Row
9.0%
|
12
|
Type of Reporting Person
IN
|
ITEM 1.
|
(a)
|
Name of Issuer:
|
Warby Parker Inc. (the “Issuer”).
|
(b)
|
Address of Issuer’s Principal Executive
Offices:
|
233 Spring Street, 6th Floor East, New York, New York
10013
ITEM 2.
|
(a)
|
Name
of Person Filing:
|
This
statement is filed on behalf of David A. Gilboa (the “Reporting Person”).
|
(b)
|
Address
or Principal Business Office:
|
The
business address of the Reporting Person is c/o Warby Parker Inc., 233 Spring Street, 6th Floor East, New York, New York 10013.
|
(c)
|
Citizenship
of each Reporting Person is:
|
David A. Gilboa is a citizen of the
United States.
|
(d)
|
Title
of Class of Securities:
|
Class A Common Stock, par value $0.0001
per share (“Class A Common Stock”).
93403J106
Not applicable.
(a-c)
The ownership information presented
below represents beneficial ownership of Class A Common Stock of the Issuer as of December 31, 2021, based upon 94,129,746 shares of Class
A Common Stock outstanding as of November 9, 2021, based on the Issuer’s amended Quarterly Report on Form 10-Q/A filed with the
Securities and Exchange Commission on November 17, 2021.
Reporting Person
|
|
Amount
beneficially
owned
|
|
|
Percent
of class:
|
|
|
Sole power
to vote or to
direct the
vote:
|
|
|
Shared power
to vote or to
direct the vote:
|
|
|
Sole
power to
dispose or
to direct
the
disposition
of:
|
|
|
Shared
power to
dispose or
to direct
the
disposition
of:
|
|
David A. Gilboa
|
|
|
9,334,815
|
|
|
|
9.0
|
%
|
|
|
7,278,045
|
|
|
|
2,056,770
|
|
|
|
7,278,045
|
|
|
|
2,056,770
|
|
Mr. Gilboa may be deemed to beneficially
own 9,334,815 shares of Class A Common Stock, which consists of (i) 6,555,796 shares of Class B Common Stock of the Issuer, which are
convertible into Class A Common Stock on a one-for-one basis at the holder’s option, held of record by Mr. Gilboa, (ii) 722,249
shares underlying options to purchase Class B Common Stock that are currently exercisable or will be exercisable within 60 days of December
31, 2021, and (iii) 2,056,770 shares of Class B Common Stock held by a family trust over which Mr. Gilboa may be deemed to share beneficial
ownership.
ITEM 5.
|
Ownership
of Five Percent or Less of a Class.
|
Not applicable.
ITEM 6.
|
Ownership
of More than Five Percent on Behalf of Another Person.
|
Not applicable.
ITEM 7.
|
Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding
Company.
|
Not applicable.
ITEM 8.
|
Identification
and Classification of Members of the Group.
|
Not applicable.
ITEM 9.
|
Notice
of Dissolution of Group.
|
Not applicable.
Not applicable.
SIGNATURE
After reasonable inquiry and to the best of my
knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
Date: February 14, 2022
|
David A. Gilboa
|
|
|
|
/s/ David A. Gilboa
|
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