0001127602-23-003250.txt : 20230203 0001127602-23-003250.hdr.sgml : 20230203 20230203101350 ACCESSION NUMBER: 0001127602-23-003250 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221231 FILED AS OF DATE: 20230203 DATE AS OF CHANGE: 20230203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BORNMANN DAVID E CENTRAL INDEX KEY: 0001215767 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-00981 FILM NUMBER: 23584121 MAIL ADDRESS: STREET 1: P.O. BOX 407 CITY: LAKELAND STATE: FL ZIP: 33802 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PUBLIX SUPER MARKETS INC CENTRAL INDEX KEY: 0000081061 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-GROCERY STORES [5411] IRS NUMBER: 590324412 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3300 PUBLIX CORPORATE PARKWAY CITY: LAKELAND STATE: FL ZIP: 33811 BUSINESS PHONE: 863-688-1188 MAIL ADDRESS: STREET 1: 3300 PUBLIX CORPORATE PARKWAY CITY: LAKELAND STATE: FL ZIP: 33811 5 1 form5.xml PRIMARY DOCUMENT X0306 5 2022-12-31 0 0 0000081061 PUBLIX SUPER MARKETS INC NONE 0001215767 BORNMANN DAVID E P.O. BOX 407 LAKELAND FL 33802 1 Senior Vice President Common Stock 433293.8162 D Common Stock 70625 I By Spouse Common Stock 23435 I By Spouse's Trust Common Stock 8000 I By Custodian for Child Common Stock 275597.0205 I By ESOP Common Stock 11197.3957 I By 401(k) SERP Stock Common Stock 32272.7705 32272.7705 I By SERP The number of shares reported as beneficially owned has been adjusted for the 5-for-1 split of Publix Super Markets, Inc. common stock effective April 14, 2022. Acquired under the Publix Super Markets, Inc. Employee Stock Ownership Plan. Transaction exempt under rule 16b-3(c). The number of shares reported had been adjusted for the 5-for-1 split of Publix Super Markets, Inc. common stock effective April 14, 2022. Acquired under the Publix Super Markets, Inc. 401(k) SMART Plan. Transaction exempt under rule 16b-3(c). The number of shares reported had been adjusted for the 5-for-1 split of Publix Super Markets, Inc. common stock effective April 14, 2022. Each share of SERP stock is the economic equivalent of one share of common stock. The shares of SERP stock become payable in common stock upon the reporting person's termination of employment in accordance with the Publix Super Markets, Inc. Supplemental Executive Retirement Plan. The number of shares reported has been adjusted for the 5-for-1 split of Publix Super Markets, Inc. common stock effective April 14, 2022. /s/ Monica Allman, POA on file for David Bornmann 2023-02-03