Statement of Changes in Beneficial Ownership (4)
December 22 2021 - 5:40PM
Edgar (US Regulatory)
FORM 4
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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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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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HOUSE PATRICIA A |
2. Issuer Name and Ticker or Trading Symbol
C3.ai, Inc.
[
AI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O C3.AI, INC., 1300 SEAPORT BLVD, SUITE 500 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/20/2021 |
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(Street)
REDWOOD CITY, CA 94063
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Class A Common Stock | 12/20/2021 | | M | | 1667 | A | $1.68 | 45397 | D | |
| Class A Common Stock | 12/20/2021 | | M | | 6250 | A | $1.86 | 51647 | D | |
| Class A Common Stock | 12/20/2021 | | M | | 3210 | A | $2.04 | 54857 | D | |
| Class A Common Stock | 12/20/2021 | | M | | 3518 | A | $3.90 | 58375 | D | |
| Class A Common Stock | 12/20/2021 | | M | | 37836 | A | $11.16 | 96211 | D | |
| Class A Common Stock | | | | | | | | 217755 | I | See Footnote (1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
| Stock Option (Right to Buy) | $1.68 | 12/20/2021 | | M | | | 1667 | (2) | 7/18/2026 | Class A Common Stock | 1667 | $0.00 | 0 | D | |
| Stock Option (Right to Buy) | $1.86 | 12/20/2021 | | M | | | 6250 | (2) | 11/29/2026 | Class A Common Stock | 6250 | $0.00 | 0 | D | |
| Stock Option (Right to Buy) | $2.04 | 12/20/2021 | | M | | | 3210 | (3) | 11/7/2027 | Class A Common Stock | 3210 | $0.00 | 19249 (4) | D | |
| Stock Option (Right to Buy) | $3.90 | 12/20/2021 | | M | | | 3518 | (5) | 11/27/2028 | Class A Common Stock | 3518 | $0.00 | 35166 (4) | D | |
| Stock Option (Right to Buy) | $11.16 | 12/20/2021 | | M | | | 37836 | (6) | 8/26/2030 | Class A Common Stock | 37836 | $0.00 | 113498 (4) | D | |
| Explanation of Responses: |
| (1) | The shares are held by the Patricia A. House 2020 2 Year GRAT created UTA dated September 22, 2020, of which the Reporting Person is trustee. |
| (2) | Fully vested. |
| (3) | Provided the Reporting Person remains a director of C3.ai, Inc. (the "Company") and attends in person the regularly scheduled meeting of the Board during each fiscal quarter, commencing on November 8, 2017, then 5% of the shares subject to the option shall vest on the last day of such fiscal quarter (the "First Option Quarterly Shares") during the term of the option, provided, however, if the Reporting Person fails to attend any such regularly scheduled meeting, then vesting for the First Option Quarterly Shares shall not occur and will be suspended (any such suspended First Option Quarterly Shares being referred to collectively as the "First Option Suspended Shares"). For any First Option Suspended Shares, such shares shall vest only following the fifth anniversary of November 8, 2017, if the Reporting Person satisfies the attendance requirements in subsequent periods. |
| (4) | Due to rounding in connection with the reverse stock split, the total shares include 1 additional share that was not originally reported on the Reporting Person's Form 3. |
| (5) | Provided the Reporting Person remains a director of the Company and attends in person the regularly scheduled meeting of the Board during each fiscal quarter, commencing on November 28, 2018, then 5% of the shares subject to the option shall vest on the last day of such fiscal quarter (the "Second Option Quarterly Shares") during the term of the option, provided, however, if the Reporting Person fails to attend any such regularly scheduled meeting, then vesting for the Second Option Quarterly Shares shall not occur and will be suspended (any such suspended Second Option Quarterly Shares being referred to collectively as the "Second Option Suspended Shares"). For any Second Option Suspended Shares, such shares shall vest only following the fifth anniversary of November 28, 2018, if the Reporting Person satisfies the attendance requirements in subsequent periods. |
| (6) | Provided the Reporting Person remains a director of the Company and attends in person the regularly scheduled meeting of the Board during each fiscal quarter, commencing on August 28, 2020, then 5% of the shares subject to the option shall vest on the last day of such fiscal quarter (the "Third Option Quarterly Shares") during the term of the option, provided, however, if the Reporting Person fails to attend any such regularly scheduled meeting, then vesting for the Third Option Quarterly Shares shall not occur and will be suspended (any such suspended Third Option Quarterly Shares being referred to collectively as the "Third Option Suspended Shares"). For any Third Option Suspended Shares, such shares shall vest only following the fifth anniversary of August 28, 2020, if the Reporting Person satisfies the attendance requirements in subsequent periods. |
Remarks:
Exhibit List
Exhibit 24 - Power of Attorney |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
HOUSE PATRICIA A
C/O C3.AI, INC.
1300 SEAPORT BLVD, SUITE 500
REDWOOD CITY, CA 94063 | X |
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Signatures
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| /s/ Richard J. Lutton, Jr., Attorney-in-Fact | | 12/22/2021 |
| **Signature of Reporting Person | Date |
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