SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
GUSTAVSON JEFF B

(Last) (First) (Middle)
6001 BOLLINGER CANYON ROAD

(Street)
SAN RAMON CA 94583

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/11/2023
3. Issuer Name and Ticker or Trading Symbol
CHEVRON CORP [ CVX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Vice President
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 3(1) I by 401(k) plan
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Non-Qualified Stock Option (Right to Buy) (2) 01/28/2025 Common Stock 7,500(3) $103.71 D
Non-Qualified Stock Option (Right to Buy) (4) 01/27/2026 Common Stock 18,650(3) $83.29 D
Non-Qualified Stock Option (Right to Buy) (5) 01/25/2027 Common Stock 4,850(3) $117.24 D
Non-Qualified Stock Option (Right to Buy) (6) 01/31/2028 Common Stock 11,300(7) $125.35 D
Non-Qualified Stock Option (Right to Buy) (8) 01/30/2029 Common Stock 13,400(9) $113.01 D
Non-Qualified Stock Option (Right to Buy) (10) 01/29/2030 Common Stock 15,600 $110.37 D
Non-Qualified Stock Option (Right to Buy) (11) 01/27/2031 Common Stock 11,934 $88.2 D
Non-Qualified Stock Option (Right to Buy) (12) 01/26/2032 Common Stock 15,900 $132.69 D
Phantom Stock Units (13) (13) Common Stock 1,206 (13) I Excess Benefit Plan
Restricted Stock Units (14) (14) Common Stock 2,038(15) (14) D
Restricted Stock Units (16) (16) Common Stock 2,249(17) (16) D
Restricted Stock Units (18) (18) Common Stock 2,278 (18) D
Restricted Stock Units (19) (19) Common Stock 2,692 (19) D
Restricted Stock Units (20) (20) Common Stock 2,926 (20) D
Restricted Stock Units (21) (21) Common Stock 4,310 (21) D
Explanation of Responses:
1. This number represents the reporting person's shares of Chevron Corporation common stock under the Chevron Corporation Employee Savings and Investment Plan, a 401(k) plan.
2. Option granted 1/28/2015. One-third of the shares subject to the option vested on each of the first, second and third anniversaries of the date of grant.
3. The Reporting Person disclaims beneficial ownership of all shares underlying these securities.
4. Option granted 1/27/2016. One-third of the shares subject to the option vested on each of the first, second and third anniversaries of the date of grant.
5. Option granted 1/25/2017. One-third of the shares subject to the option vested on January 31, 2018, January 31, 2019 and January 31, 2020, respectively.
6. Option granted 1/31/2018. One-third of the shares subject to the option vested on January 31, 2019, January 31, 2020 and January 31, 2021, respectively.
7. The Reporting Person disclaims beneficial ownership of 4,633 shares underlying these securities.
8. Option granted 1/30/2019. One-third of the shares subject to the option vested on January 31, 2020, January 31, 2021 and January 31, 2022, respectively.
9. The Reporting Person disclaims beneficial ownership of 2,822 shares underlying these securities.
10. Option granted 1/29/2020. One-third of the shares subject to the option vested on January 31, 2021, and one-third of the shares vested on January 31, 2022. The balance of the shares vests on January 31, 2023.
11. Option granted 1/27/2021. One-third of the shares subject to the option vested on January 31, 2022, and one-third of the shares subject to the option will vest on January 31, 2023 and January 31, 2024, respectively.
12. Option granted 1/26/2022. One-third of the shares subject to the option vest on January 31, 2023, January 31, 2024 and January 31, 2025, respectively.
13. Each phantom stock unit is the economic equivalent of one share of Chevron Corporation common stock. The phantom stock units, which are issued under the Chevron ESIP-RP, are payable in cash upon the reporting person's retirement or other termination of service.
14. Restricted stock units granted on January 31, 2018 under the Chevron Corporation Long-Term Incentive Plan. Each restricted stock unit is the economic equivalent of one share of Chevron Corporation common stock. Restricted stock units accrue dividend equivalents in the form of additional restricted stock units and are payable in cash upon vesting on January 31, 2023.
15. The Reporting Person disclaims beneficial ownership of 502 shares underlying these securities.
16. Restricted stock units granted on January 30, 2019 under the Chevron Corporation Long-Term Incentive Plan. Each restricted stock unit is the economic equivalent of one share of Chevron Corporation common stock. Restricted stock units accrue dividend equivalents in the form of additional restricted stock units and are payable in cash upon vesting on January 31, 2024.
17. The Reporting Person disclaims beneficial ownership of 365 shares underlying these securities.
18. Restricted stock units granted on January 29, 2020 under the Chevron Corporation Long-Term Incentive Plan. Each restricted stock unit is the economic equivalent of one share of Chevron Corporation common stock. Restricted stock units accrue dividend equivalents in the form of additional restricted stock units and are payable in cash upon vesting on January 31, 2025.
19. Restricted stock units granted on January 27, 2021 under the Chevron Corporation Long-Term Incentive Plan. Each restricted stock unit is the economic equivalent of one share of Chevron Corporation common stock. Restricted stock units accrue dividend equivalents in the form of additional restricted stock units and are payable in cash upon vesting on January 31, 2026.
20. Restricted stock units granted on January 26, 2022 under the Chevron Corporation Long-Term Incentive Plan. Each restricted stock unit is the economic equivalent of one share of Chevron Corporation common stock. Restricted stock units accrue dividend equivalents in the form of additional restricted stock units and are payable in cash upon vesting on January 31, 2027.
21. Restricted stock units granted on January 27, 2021 under the Chevron Corporation Long-Term Incentive Plan. Each restricted stock unit is the economic equivalent of one share of Chevron Corporation common stock. Restricted stock units accrue dividend equivalents in the form of additional restricted stock units and are payable in cash upon vesting on January 31, 2024.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Rose Z. Pierson, Attorney-in-Fact for Jeff B. Gustavson 01/18/2023
** 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 5 (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.
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