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Form 3 Warby Parker Inc. For: Sep 21 Filed by: Raider Jeffrey Jacob

September 21, 2021 9:16 PM EDT
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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 *
Raider Jeffrey Jacob

(Last) (First) (Middle)
C/O WARBY PARKER INC.
233 SPRING STREET, 6TH FLOOR EAST

(Street)
NEW YORK NY 10013

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/21/2021
3. Issuer Name and Ticker or Trading Symbol
Warby Parker Inc. [ WRBY ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Class A Common Stock 450,210
D
 
Class A Common Stock 1,519,661 (1)
I
By Trust
Class A Common Stock 2,538,071 (1)
I
By Trust
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock   (2)   (2) Class A Common Stock 2,538,071 (1) (2) I By Trust
Class B Common Stock   (2)   (2) Class A Common Stock 253,808 (1) (2) I By Trust
Explanation of Responses:
1. Each share of the Issuer's Class B Common Stock is convertible into one share of the Issuer's Class A Common Stock at the option of the holder and has no expiration date.
2. Consists of: (i) 1,519,661 shares of Class A common stock held by The Jeffrey J. Raider 2011 Family Trust, or the JJR 2011 Family Trust, for which Mr. Raiders spouse Laura Raider is the trustee; (ii) 2,538,071 shares of Class B common stock held by DAG WP Holdings LLC, or DAG WP LLC, for which Mr. Raider is the manager; (iii) 253,808 shares of Class B common stock held by Ruth Gilboa 2017 GST-Exempt Trust, or the Gilboa 2017 Trust, for which Mr. Raider is the trustee and (iv) 2,538,071 shares of Class A common stock held by AMH WP Holdings LLC, for which Mr. Raider is the trustee of its sole manager. Mr. Raider may be deemed to have voting power and dispositive power over the shares held by the JJR 2011 Family Trust, DAG WP LLC, the Gilboa 2017 Trust, and AMH WP Holdings LLC.
Remarks:
EXHIBIT LIST: EX-24 POA - Jacob Raider
/s/ Hyung Bak, Attorney-in-Fact 09/21/2021
** 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.
POWER OF ATTORNEY

With respect to holdings of and transactions in securities issued by Warby Parker Inc. (the "Company"), the undersigned hereby constitutes and appoints the individuals named on Appendix A attached hereto and as may be amended from time to time, or any of them signing singly, with full power of substitution and resubstitution, to act as the undersigned's true and lawful attorney-in-fact to:
1.    prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the United States Securities and Exchange Commission (the "SEC") a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain and/or regenerate codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section 16(a) of the Securities Exchange Act of 1934, as amended, or any rule or regulation of the SEC;
2.    execute for and on behalf of the undersigned, Forms 3, 4, and 5 in accordance with Section 16 of the Securities Exchange Act of 1934, as amended, and the rules thereunder;
3.    do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such form with the SEC and any stock exchange or similar authority; and
4.    take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-facts discretion.
The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution and resubstitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorneys-in-fact substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted.  
The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is any Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended.
This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact. 
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 17th day of September, 2021.

By:  /s/ Jeffrey Raider            

Name:  Jeffrey Raider            




 

Appendix A

Individuals Appointed as Attorney-in-Fact with Full Power of Substitution and Resubstitution

1.    Steven Miller
2.    Hyung Bak


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