Initial Statement of Beneficial Ownership (3)
15 November 2022 - 8:49AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
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3235-0104
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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
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Hayden Timothy John |
2. Date of Event Requiring Statement (MM/DD/YYYY)
11/1/2022
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3. Issuer Name and Ticker or Trading Symbol
Agrify Corp [AGFY]
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(Last)
(First)
(Middle)
C/O AGRIFY CORPORATION, 76 TREBLE COVE ROAD, BUILDING 3 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) Chief Revenue Officer / |
(Street)
BILLERICA, MA 01862
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 Unit (1) | (2) | 9/29/2032 | Common Stock | 7500 | (3) | D | |
Explanation of Responses: |
(1) | Grant of restricted stock units under to the Agrify Corporation 2022 Omnibus Equity Incentive Plan. |
(2) | The restricted stock units will vest in three equal installments on September 29, 2023, September 29, 2024 and September 29, 2025, subject to the reporting person's continuous service through each applicable vesting date. |
(3) | Each restricted stock unit represents the right to receive, at settlement, one share of common stock of the issuer. |
Remarks: Exhibit List: Exhibit 24.1 - Power of Attorney |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Hayden Timothy John C/O AGRIFY CORPORATION 76 TREBLE COVE ROAD, BUILDING 3 BILLERICA, MA 01862 |
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| Chief Revenue Officer |
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Signatures
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/s/ Josh Savitz, attorney-in-fact | | 11/14/2022 |
**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 control number. |
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