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*
Scaringe Robert J
(Last) (First) (Middle)
C/O RIVIAN AUTOMOTIVE, INC.
14600 MYFORD ROAD
(Street)
IRVINE CA 92606
(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/09/2021 		3. Issuer Name and Ticker or Trading Symbol
Rivian Automotive, Inc. / DE [ RIVN ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
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 4,337,997 I By Trust
Class A Common Stock 4,595 I By LLC
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 (1) (1) Class A Common Stock 7,825,000 $0.00 I By LLC
Stock Option (2) 03/15/2029 Class A Common Stock 8,699,550 $2.63 D
Stock Option (3) 07/08/2029 Class A Common Stock 1,000,000 $3.36 D
Stock Option (4) 01/19/2031 Class A Common Stock 27,141,261 $21.72 D
Explanation of Responses:
1. The Class B Common Stock is convertible at any time at the option of the holder into the Issuer's Class A Common Stock on a one-to-one basis. The Class B Common Stock will automatically convert into shares of the Issuer's Class A Common Stock on a one-to-one basis upon the earliest of (a) a date fixed by the Issuer's board of directors that is not less than 60 days nor more than 180 days following the death or disability of the Reporting Person, (b) the five year anniversary of the date of the closing of the Issuer's initial public offering ("IPO") and (c) the date fixed by the Issuer's board of directors that is no less than 61 days and no more than 180 days following the date that the number of outstanding shares of Class B Common Stock represents less than 30% of the shares of Class B Common Stock outstanding immediately following the IPO.
2. The stock option is vested and exercisable as to 62.5% of the underlying shares and the remaining shares will vest and become exercisable as to 12.5% of the underlying shares on each of February 24, 2022, August 14, 2022 and February 14, 2023.
3. The stock option vests upon the completion of the 5,000th production vehicle by the Issuer and its subsidiaries.
4. The stock option vests as to (i) 6,785,315 shares underlying the stock option in 6 substantially equal annual installments beginning on the first anniversary of the Issuer's IPO and (ii) 20,355,946 shares underlying the stock option vest subject to the per share price of the Issuer's Class A Common Stock exceeding various thresholds.
Remarks:
Exhibit 24 - Power of Attorney.
/s/ Neil Sitron, Attorney-in-Fact 11/09/2021
** 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 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.
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