0001209191-23-026943.txt : 20230503 0001209191-23-026943.hdr.sgml : 20230503 20230503161323 ACCESSION NUMBER: 0001209191-23-026943 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221212 FILED AS OF DATE: 20230503 DATE AS OF CHANGE: 20230503 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HOUSE PATRICIA A CENTRAL INDEX KEY: 0001241633 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39744 FILM NUMBER: 23883927 MAIL ADDRESS: STREET 1: C/O C3.AI, INC. STREET 2: 1400 SEAPORT BLVD 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: 0430 BUSINESS ADDRESS: STREET 1: 1400 SEAPORT BLVD CITY: REDWOOD CITY STATE: CA ZIP: 94063 BUSINESS PHONE: 650-503-2200 MAIL ADDRESS: STREET 1: 1400 SEAPORT BLVD 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 X0407 4 2022-12-12 1 0001577526 C3.ai, Inc. AI 0001241633 HOUSE PATRICIA A C/O C3.AI, INC. 1400 SEAPORT BLVD REDWOOD CITY CA 94063 0 0 0 1 Former Director 0 Class A Common Stock 2022-12-12 4 G 0 217755 0.00 D 0 I See Footnote Class A Common Stock 2022-12-12 4 G 0 217755 0.00 A 313966 D 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. /s/ Eric Jensen, Attorney-in-Fact 2023-05-03