0001209191-20-062930.txt : 20201211
0001209191-20-062930.hdr.sgml : 20201211
20201211161704
ACCESSION NUMBER: 0001209191-20-062930
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200827
FILED AS OF DATE: 20201211
DATE AS OF CHANGE: 20201211
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SIEBEL THOMAS M
CENTRAL INDEX KEY: 0001031530
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39744
FILM NUMBER: 201383755
MAIL ADDRESS:
STREET 1: SIEBEL SYSTEMS INC
STREET 2: 2207 BRIDGEPOINTE PARKWAY
CITY: SAN MATEO
STATE: CA
ZIP: 94404
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Siebel Living Trust u/a/d 7/27/93, as amended
CENTRAL INDEX KEY: 0001834425
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39744
FILM NUMBER: 201383756
BUSINESS ADDRESS:
STREET 1: C/O C3.AI, INC.
STREET 2: 1300 SEAPORT BLVD., SUITE 500
CITY: REDWOOD CITY
STATE: CA
ZIP: 94063
BUSINESS PHONE: 650-503-2200
MAIL ADDRESS:
STREET 1: C/O C3.AI, INC.
STREET 2: 1300 SEAPORT BLVD., SUITE 500
CITY: REDWOOD CITY
STATE: CA
ZIP: 94063
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: C3.ai, Inc.
CENTRAL INDEX KEY: 0001577526
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 263999357
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1300 SEAPORT BLVD
STREET 2: SUITE 500
CITY: REDWOOD CITY
STATE: CA
ZIP: 94063
BUSINESS PHONE: 650-503-2218
MAIL ADDRESS:
STREET 1: 1300 SEAPORT BLVD
STREET 2: SUITE 500
CITY: REDWOOD CITY
STATE: CA
ZIP: 94063
FORMER COMPANY:
FORMER CONFORMED NAME: C3 IoT, Inc.
DATE OF NAME CHANGE: 20180123
FORMER COMPANY:
FORMER CONFORMED NAME: C3, Inc.
DATE OF NAME CHANGE: 20130522
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2020-08-27
0
0001577526
C3.ai, Inc.
AI
0001031530
SIEBEL THOMAS M
C/O C3.AI, INC.
1300 SEAPORT BLVD, SUITE 500
REDWOOD CITY
CA
94603
1
1
1
0
Chief Executive Officer
0001834425
Siebel Living Trust u/a/d 7/27/93, as amended
C/O C3.AI, INC.
1300 SEAPORT BLVD, SUITE 500
REDWOOD CITY
CA
94063
0
0
1
0
Class A Common Stock
2020-12-11
4
C
0
170294
A
170294
I
See Footnote
Class A Common Stock
2020-12-11
4
C
0
72695
A
72695
I
See Footnote
Class A Common Stock
2020-12-11
4
C
0
1335383
A
12057527
I
See Footnote
Class A Common Stock
2020-12-11
4
C
0
9216
A
9216
I
See Footnote
Class A Common Stock
2020-12-11
4
C
0
146198
A
1237115
I
See Footnote
Class A Common Stock
2175666
D
Series B* Convertible Preferred Stock
2020-12-11
4
C
0
140165
0.00
D
Class A Common Stock
140165
0
I
See Footnote
Series B* Convertible Preferred Stock
2020-12-11
4
C
0
59834
0.00
D
Class A Common Stock
59834
0
I
See Footnote
Series B-1A* Convertible Preferred Stock
2020-12-11
4
C
0
30129
0.00
D
Class A Common Stock
30129
0
I
See Footnote
Series B-1A* Convertible Preferred Stock
2020-12-11
4
C
0
12861
0.00
D
Class A Common Stock
12861
0
I
See Footnote
Series B-1A* Convertible Preferred Stock
2020-12-11
4
C
0
38343
0.00
D
Class A Common Stock
38343
0
I
See Footnote
Series B-1B* Convertible Preferred Stock
2020-12-11
4
C
0
9216
0.00
D
Class A Common Stock
9216
0
I
See Footnote
Series B-1B* Convertible Preferred Stock
2020-12-11
4
C
0
45120
0.00
D
Class A Common Stock
45120
0
I
See Footnote
Series C Convertible Preferred
2020-12-11
4
C
0
146198
0.00
D
Class A Common Stock
146198
0
I
See Footnote
Series F Convertible Preferred
2020-12-11
4
C
0
1251920
0.00
D
Class A Common Stock
1251920
0
I
See Footnote
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.
The shares are held by Siebel Asset Management, L.P., of which the Reporting Person is the general partner.
The shares are held by Siebel Asset Management III, L.P., of which the Reporting Person is the general partner.
The shares are held by The Siebel Living Trust u/a/d 7/27/93, a amended, of which the Reporting Person is trustee.
The shares are held by First Virtual Holdings, LLC, of which the Reporting Person is Chairman.
The shares are held by The Siebel 2011 Irrevocable Children's Trust, of which the Reporting Person is co-trustee.
Two of two filings made for the Reporting Persons.
/s/ Brady Mickelsen, Attorney-in-Fact
2020-12-11
/s/ Brady Mickelsen, Attorney-in-Fact
2020-12-11