| 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 12/15/2023 |
3. Issuer Name and Ticker or Trading Symbol
Symbotic Inc. [ SYM ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 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) |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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 | ||||
| Restricted Stock Units | (1) | (1) | Class A Common Stock | 171,027 | (2) | D | |
| Explanation of Responses: |
| 1. The restricted stock units, which were granted on November 3, 2023, vest as follows: 1/3 of the restricted stock units vest on November 3, 2024, and 1/12 of the restricted stock units vest quarterly thereafter, subject to the Reporting Person's continued service with the Issuer on the applicable vesting dates. |
| 2. Each restricted stock unit represents a contingent right to receive one share of the Issuer's Class A common stock. |
| Remarks: |
| Exhibit List: 24.1 - Power of Attorney. |
| /s/ Corey Dufresne, Attorney-in-Fact for Carol J. Hibbard | 12/15/2023 | |
| ** 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 by 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, passphrases 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 December 12, 2023.
By: /s/ Carol Hibbard
(Sign Name)
Carol Hibbard
(Print Name)
Schedule 1
ATTORNEYS-IN-FACT
•William Boyd, III
•Corey Dufresne
•Kristen Galbreath