Form 3 INTERFACE INC For: May 16 Filed by: O'Brien Robert T
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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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OMB APPROVAL |
OMB Number: |
3235-0104 |
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December 31, 2014 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person
*
1280 WEST PEACHTREE ST NW |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/16/2022
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3. Issuer Name
and
Ticker or Trading Symbol
INTERFACE INC
[
TILE
]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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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)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting
Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of Responses: |
Remarks: |
Exhibit List: Exhibit 24 - Confirming Statement |
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/s/ David B. Foshee, Attorney in Fact |
05/18/2022 |
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** 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
4
(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. |
CONFIRMING STATEMENT
This Statement confirms that the undersigned, Robert T. O'Brien,
has authorized and designated each of David B. Foshee and
J. Gregory Minano, signing singly, to execute and file on the
undersigned's behalf all Forms 3, 4, and 5 (including any
amendments thereto) that the undersigned may be required
to file with the U.S. Securities and Exchange Commission
as a result of the undersigned's ownership of or transactions
in securities of Interface, Inc. The authority of Mr. Foshee
and Mr. Minano under this Statement shall continue until
the undersigned is no longer required to file Forms 3, 4,
and 5 with regard to the undersigned's ownership of or
transactions in securities of Interface, Inc., unless earlier
revoked in writing. The undersigned acknowledges that
neither David B. Foshee nor J. Gregory Minano is
assuming any of the undersigned's responsibilities to comply
with Section 16 of the Securities Exchange Act of 1934.
/s/ Robert T. O'Brien
Robert T. O'Brien
Date: May 18, 2022