0000899243-21-045166.txt : 20211117 0000899243-21-045166.hdr.sgml : 20211117 20211117194601 ACCESSION NUMBER: 0000899243-21-045166 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211115 FILED AS OF DATE: 20211117 DATE AS OF CHANGE: 20211117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Boone Karen CENTRAL INDEX KEY: 0001561290 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41042 FILM NUMBER: 211422178 MAIL ADDRESS: STREET 1: 15 KOCH ROAD STREET 2: SUITE J CITY: CORTE MADERA STATE: CA ZIP: 94925 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Rivian Automotive, Inc. / DE CENTRAL INDEX KEY: 0001874178 STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLES & PASSENGER CAR BODIES [3711] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 14600 MYFORD ROAD CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: (888) 748-4261 MAIL ADDRESS: STREET 1: 14600 MYFORD ROAD CITY: IRVINE STATE: CA ZIP: 92618 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-11-15 0 0001874178 Rivian Automotive, Inc. / DE RIVN 0001561290 Boone Karen C/O RIVIAN AUTOMOTIVE, INC. 14600 MYFORD ROAD IRVINE CA 92606 1 0 0 0 Class A Common Stock 2021-11-15 4 P 0 20000 78.00 A 20209 D Class A Common Stock 65000 I See footnote Class A Common Stock 65000 I See footnote By The Andrew J. Boone 2021 Grantor Retained Annuity Trust under Irrevocable Trust Agreement dated September 24, 2021. By The Karen L. Boone 2021 Grantor Retained Annuity Trust under Irrevocable Trust Agreement dated September 24, 2021. /s/ Neil Sitron, Attorney-in-Fact 2021-11-17