0000899243-22-026488.txt : 20220721 0000899243-22-026488.hdr.sgml : 20220721 20220721170038 ACCESSION NUMBER: 0000899243-22-026488 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220719 FILED AS OF DATE: 20220721 DATE AS OF CHANGE: 20220721 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ford Rollin L. CENTRAL INDEX KEY: 0001429247 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40175 FILM NUMBER: 221097661 MAIL ADDRESS: STREET 1: 702 S.W. 8TH STREET STREET 2: MAIL STOP # 0215 CITY: BENTONVILLE STATE: AR ZIP: 72716-0215 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Symbotic Inc. CENTRAL INDEX KEY: 0001837240 STANDARD INDUSTRIAL CLASSIFICATION: GENERAL INDUSTRIAL MACHINERY & EQUIPMENT, NEC [3569] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 200 RESEARCH DRIVE CITY: WILMINGTON STATE: MA ZIP: 01887 BUSINESS PHONE: 978-284-2800 MAIL ADDRESS: STREET 1: 200 RESEARCH DRIVE CITY: WILMINGTON STATE: MA ZIP: 01887 FORMER COMPANY: FORMER CONFORMED NAME: SVF Investment Corp. 3 DATE OF NAME CHANGE: 20210128 FORMER COMPANY: FORMER CONFORMED NAME: SVF Investment III Corp. DATE OF NAME CHANGE: 20201218 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2022-07-19 0 0001837240 Symbotic Inc. SYM 0001429247 Ford Rollin L. C/O SYMBOTIC INC., 200 RESEARCH DRIVE WILMINGTON MA 01887 1 0 0 0 Class V-1 Common Stock 2022-07-19 4 A 0 31020 A 1212420 I By Spouse Symbotic Holdings Units 2022-07-19 4 A 0 31020 A Class A Common Stock 31020 1212420 I By Spouse Represents Symbotic Holdings Units issued on July 19, 2022 as Earnout Interests following the occurrence of Triggering Event I and Triggering Event II in connection with the Agreement and Plan of Merger, dated December 12, 2021, by and among the Issuer, Saturn Acquisition (DE) Corp., Warehouse Technologies LLC and Symbotic Holdings LLC ("Symbotic Holdings"), as described in the Issuer's final prospectus filed with the Securities and Exchange Commission on June 1, 2022. The term "Symbotic Holdings Units" is used herein to represent limited liability company units of Symbotic Holdings and an equal number of paired shares of Class V-1 Common Stock of the Issuer, which, pursuant to the limited liability company agreement of Symbotic Holdings, are together redeemable by the holder on a one-for-one basis for a share of Class A Common Stock of the Issuer, subject to conversion rate adjustments for stock splits, stock dividends, reclassification and other similar transactions, and in accordance with other terms and conditions set forth in Symbotic Holdings' Second Amended and Restated Limited Liability Company Agreement, dated as of June 7, 2022. Upon redemption, the Issuer will cancel the Symbotic Holdings Units and cancel and retire for no consideration the redeemed shares of Class V-1 Common Stock. Shares of Class V-1 Common Stock of the Issuer have no economic rights and each share of Class V-1 Common Stock entitles its holder to 1 vote per share. The amount of securities beneficially owned following the reported transactions in Table I does not include shares of other classes of the Issuer's securities held directly or indirectly by the Reporting Person that are reported on preceding Form 4 filings. Rollin Ford may be considered to have an indirect pecuniary interest in an additional 10,340 Symbotic Holdings Units issued on July 19, 2022 to the Audrey Exempt Trust, u/a, an additional 10,340 Symbotic Holdings Units issued on July 19, 2022 to the Jessica Exempt Trust, u/a, and an additional 10,340 Symbotic Holdings Units issued on July 19, 2022 to the Paige Exempt Trust, u/a (collectively the "Trust Shares"), each of which has Mr. Ford's spouse as a Trustee and to which members of Mr. Ford's immediate family have a pecuniary interest. Rollin Ford does not have voting or investment control over the Trust Shares and disclaims beneficial ownership of the Trust Shares except to the extent that Mr. Ford may be considered to have an indirect pecuniary interest therein. This report shall not be deemed an admission that the Reporting Person is the beneficial owner of the Trust Shares for purposes of Section 16 or for any other purpose. /s/ Corey Dufresne, Attorney-in-Fact 2022-07-21