SEC FORM 3 SEC Form 3
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*
Cohen Richard B

(Last) (First) (Middle)
C/O SYMBOTIC INC., 200 RESEARCH DRIVE

(Street)
WILMINGTON MA 01887

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/07/2022
3. Issuer Name and Ticker or Trading Symbol
Symbotic Inc. [ SYM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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 V-3 Common Stock(1)(2) 0(1) I(1) See Footnote(1)
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
Symbotic Holdings Units(1)(2) (1) (1) Class A Common Stock (1) (1) I(1) See Footnote(1)
1. Name and Address of Reporting Person*
Cohen Richard B

(Last) (First) (Middle)
C/O SYMBOTIC INC., 200 RESEARCH DRIVE

(Street)
WILMINGTON MA 01887

(City) (State) (Zip)
1. Name and Address of Reporting Person*
RBC 2021 4 Year GRAT

(Last) (First) (Middle)
C/O SYMBOTIC INC., 200 RESEARCH DRIVE

(Street)
WILMINGTON MA 01887

(City) (State) (Zip)
1. Name and Address of Reporting Person*
RJJRP Holdings, Inc.

(Last) (First) (Middle)
C/O SYMBOTIC INC., 200 RESEARCH DRIVE

(Street)
WILMINGTON MA 01887

(City) (State) (Zip)
Explanation of Responses:
1. Represents Symbotic Holdings Units received as consideration for limited liability company units of Warehouse Technologies LLC ("Warehouse") in connection with the Agreement and Plan of Merger, dated December 12, 2021, by and among the Issuer, Saturn Acquisition (DE) Corp., Warehouse 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. Certain of the Reporting Persons received Symbotic Holdings Units in connection with the closing of such business combination, which acquisitions will be reported separately on a Form 4 on the date hereof.
2. 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-3 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. Upon redemption, the Issuer will cancel the Symbotic Holdings Units and cancel and retire for no consideration the redeemed shares of Class V-3 Common Stock. Shares of Class V-3 Common Stock of the Issuer have no economic rights and each share of Class V-3 Common Stock entitles its holder to 3 votes per share.
Remarks:
Board Chair, President and Chief Product Officer Exhibit Lists: Exhibit 24.1- Power of Attorney for Richard B. Cohen. Exhibit 24.2- Power of Attorney for RBC 2021 4 Year GRAT. Exhibit 24.3- Power of Attorney for RJJRP Holdings, Inc.
/s/ Corey Dufresne, Attorney-in-Fact for Richard B. Cohen 06/09/2022
/s/ Corey Dufresne, Attorney-in-Fact for RBC 2021 4 Year GRAT 06/09/2022
/s/ Corey Dufresne, Attorney-in-Fact for RJJRP Holdings, Inc. 06/09/2022
** 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 5 (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 Symbotic Inc. (the "Company"), the undersigned hereby constitutes and
appoints the persons named on Schedule 1 attached hereto, as may be amended
from time to time (the "Attorneys-in-Fact"), including an Attorney-in-Fact
acting or 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 U.S. 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 of the Securities Exchange Act of 1934, as amended, and
the rules and regulations promulgated thereunder;

                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 and regulations promulgated thereunder;

                3. do and perform any and all acts for and on behalf of the
undersigned that 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 that, in the opinion of such Attorneys-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 Attorneys-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 Attorneys-in-Fact may
approve in such Attorneys-in-Fact's discretion.

             The undersigned hereby grants to each such Attorneys-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 Attorneys-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 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 Attorneys-in-Fact.

             IN WITNESS WHEREOF, the undersigned has caused this power of
attorney to be executed as of this 2nd day of June, 2022.

                                   By:       /s/ Richard B. Cohen
                                       -------------------------------
                                                  (Sign Name)

                                             Richard B. Cohen
                                       -------------------------------
                                                  (Print Name)


                                Schedule 1
                            ATTORNEYS-IN-FACT

 Corey Dufresne

 Kristen Galbreath

 Sullivan & Cromwell LLP
                                POWER OF ATTORNEY

             With respect to holdings of and transactions in securities issued
by Symbotic Inc. (the "Company"), the undersigned hereby constitutes and
appoints the persons named on Schedule 1 attached hereto, as may be amended
from time to time (the "Attorneys-in-Fact"), including an Attorney-in-Fact
acting or 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 U.S. 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 of the Securities Exchange Act of 1934, as amended, and
the rules and regulations promulgated thereunder;

                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 and regulations promulgated thereunder;

                3. do and perform any and all acts for and on behalf of the
undersigned that 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 that, in the opinion of such Attorneys-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 Attorneys-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 Attorneys-in-Fact may
approve in such Attorneys-in-Fact's discretion.

             The undersigned hereby grants to each such Attorneys-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 Attorneys-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 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 Attorneys-in-Fact.

             IN WITNESS WHEREOF, the undersigned has caused this power of
attorney to be executed as of this 2nd day of June, 2022.


                                   The RBC 2021 4 Year GRAT

                                   By: /s/ Richard B. Cohen
                                       -------------------------------
                                   Name: Richard B. Cohen

                                   Title: As Trustee (and not individually)


                                Schedule 1
                            ATTORNEYS-IN-FACT

 Corey Dufresne

 Kristen Galbreath

 Sullivan & Cromwell LLP
                                POWER OF ATTORNEY

             With respect to holdings of and transactions in securities issued
by Symbotic Inc. (the "Company"), the undersigned hereby constitutes and
appoints the persons named on Schedule 1 attached hereto, as may be amended
from time to time (the "Attorneys-in-Fact"), including an Attorney-in-Fact
acting or 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 U.S. 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 of the Securities Exchange Act of 1934, as amended, and
the rules and regulations promulgated thereunder;

                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 and regulations promulgated thereunder;

                3. do and perform any and all acts for and on behalf of the
undersigned that 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 that, in the opinion of such Attorneys-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 Attorneys-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 Attorneys-in-Fact may
approve in such Attorneys-in-Fact's discretion.

             The undersigned hereby grants to each such Attorneys-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 Attorneys-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 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 Attorneys-in-Fact.

             IN WITNESS WHEREOF, the undersigned has caused this power of
attorney to be executed as of this 2nd day of June, 2022.

                                   RJJRP Holdings, Inc.

                                   By: /s/ Richard B. Cohen
                                       -------------------------------
                                   Name: Richard B. Cohen
                                   Title: President and Chief Executive Officer


                                   Schedule 1
                               ATTORNEYS-IN-FACT

 Corey Dufresne

 Kristen Galbreath

 Sullivan & Cromwell LLP