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*
BOYCE RICHARD W

(Last) (First) (Middle)
C/O ALLBIRDS, INC.
733 MONTGOMERY STREET

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/02/2021
3. Issuer Name and Ticker or Trading Symbol
Allbirds, Inc. [ BIRD ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
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 772,725 $0.00 D
Class B Common Stock (1) (1) Class A Common Stock 46,555 $0.00 I By Trust(2)
Series Seed Preferred Stock (3) (3) Class B Common Stock(1) 171,350 $0.00 I By Trust(2)
Series A Preferred Stock (3) (3) Class B Common Stock(1) 833,640 $0.00 I By Trust(2)
Series B Preferred Stock (3) (3) Class B Common Stock(1) 25,780 $0.00 I By Trust(2)
Explanation of Responses:
1. Each share of Class B Common Stock is convertible at any time at the option of the Reporting Person into one share of Class A Common Stock and has no expiration date. Each share of Class B Common Stock held by the Reporting Person will convert automatically into one share of Class A Common Stock upon the sale or transfer of such share of Class B Common Stock, subject to certain exceptions, and in certain other circumstances described in the Issuer's amended and restated certificate of incorporation.
2. Shares are held of record by the Dick W. Boyce & Sandy W. Boyce Revocable Trust Agreement Dated December 30, 1994, of which the Reporting Person is co-trustee and shares voting and investment power over such shares.
3. Each share of Preferred Stock is convertible into one share of Class B Common Stock and has no expiration date. Immediately prior to the closing of the Issuer's initial public offering, each share of Preferred Stock will be automatically converted into one share of Class B Common Stock.
Remarks:
Richard W. Boyce, by /s/ Ron A. Metzger, Attorney-in-Fact 11/02/2021
** 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.
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.