Living Trust u/a/d 7/27/93, as amended Siebel
Filed: 11 Dec 20, 4:17pm
| FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol C3.ai, Inc. [ AI ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 08/27/2020 | ||||||||||||||||||||||||||
| 4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Class A Common Stock | 12/11/2020 | C | 170,294 | A | (1) | 170,294 | I | See Footnote(2) | ||
| Class A Common Stock | 12/11/2020 | C | 72,695 | A | (1) | 72,695 | I | See Footnote(3) | ||
| Class A Common Stock | 12/11/2020 | C | 1,335,383 | A | (1) | 12,057,527 | I | See Footnote(4) | ||
| Class A Common Stock | 12/11/2020 | C | 9,216 | A | (1) | 9,216 | I | See Footnote(5) | ||
| Class A Common Stock | 12/11/2020 | C | 146,198 | A | (1) | 1,237,115 | I | See Footnote(6) | ||
| Class A Common Stock | 2,175,666 | D | ||||||||
| Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Series B* Convertible Preferred Stock | (1) | 12/11/2020 | C | 140,165 | (1) | (1) | Class A Common Stock | 140,165 | $0.00 | 0 | I | See Footnote(2) | |||
| Series B* Convertible Preferred Stock | (1) | 12/11/2020 | C | 59,834 | (1) | (1) | Class A Common Stock | 59,834 | $0.00 | 0 | I | See Footnote(3) | |||
| Series B-1A* Convertible Preferred Stock | (1) | 12/11/2020 | C | 30,129 | (1) | (1) | Class A Common Stock | 30,129 | $0.00 | 0 | I | See Footnote(2) | |||
| Series B-1A* Convertible Preferred Stock | (1) | 12/11/2020 | C | 12,861 | (1) | (1) | Class A Common Stock | 12,861 | $0.00 | 0 | I | See Footnote(3) | |||
| Series B-1A* Convertible Preferred Stock | (1) | 12/11/2020 | C | 38,343 | (1) | (1) | Class A Common Stock | 38,343 | $0.00 | 0 | I | See Footnote(4) | |||
| Series B-1B* Convertible Preferred Stock | (1) | 12/11/2020 | C | 9,216 | (1) | (1) | Class A Common Stock | 9,216 | $0.00 | 0 | I | See Footnote(5) | |||
| Series B-1B* Convertible Preferred Stock | (1) | 12/11/2020 | C | 45,120 | (1) | (1) | Class A Common Stock | 45,120 | $0.00 | 0 | I | See Footnote(4) | |||
| Series C Convertible Preferred | (1) | 12/11/2020 | C | 146,198 | (1) | (1) | Class A Common Stock | 146,198 | $0.00 | 0 | I | See Footnote(6) | |||
| Series F Convertible Preferred | (1) | 12/11/2020 | C | 1,251,920 | (1) | (1) | Class A Common Stock | 1,251,920 | $0.00 | 0 | I | See Footnote(4) | |||
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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| Explanation of Responses: |
| 1. Immediately upon the closing of the Issuer's initial public offering, all shares of Series B* Convertible Preferred Stock, Series B-1A* Convertible Preferred Stock, Series B-1B* Convertible Preferred Stock, Series C Convertible Preferred Stock and Series F Convertible Preferred Stock automatically converted into shares of Class A Common Stock and had no expiration date. |
| 2. The shares are held by Siebel Asset Management, L.P., of which the Reporting Person is the general partner. |
| 3. The shares are held by Siebel Asset Management III, L.P., of which the Reporting Person is the general partner. |
| 4. The shares are held by The Siebel Living Trust u/a/d 7/27/93, a amended, of which the Reporting Person is trustee. |
| 5. The shares are held by First Virtual Holdings, LLC, of which the Reporting Person is Chairman. |
| 6. The shares are held by The Siebel 2011 Irrevocable Children's Trust, of which the Reporting Person is co-trustee. |
| Remarks: |
| Two of two filings made for the Reporting Persons. |
| /s/ Brady Mickelsen, Attorney-in-Fact | 12/11/2020 | |
| /s/ Brady Mickelsen, Attorney-in-Fact | 12/11/2020 | |
| ** 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. | ||