0001209191-21-060492.txt : 20211014 0001209191-21-060492.hdr.sgml : 20211014 20211014173420 ACCESSION NUMBER: 0001209191-21-060492 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211012 FILED AS OF DATE: 20211014 DATE AS OF CHANGE: 20211014 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Barter David CENTRAL INDEX KEY: 0001706672 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39744 FILM NUMBER: 211324149 MAIL ADDRESS: STREET 1: C/O MODEL N, INC., 1600 SEAPORT BLVD. STREET 2: SUITE 400 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: 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 2021-10-12 0 0001577526 C3.ai, Inc. AI 0001706672 Barter David C/O C3.AI, INC. 1300 SEAPORT BLVD, SUITE 500 REDWOOD CITY CA 94063 0 1 0 0 Senior VP and CFO Class A Common Stock 2021-10-12 4 M 0 233332 17.10 A 233332 D Class A Common Stock 2021-10-12 4 S 0 170333 45.04 D 62999 D Stock Option (Right to Buy) 17.10 2021-10-12 4 M 0 233332 0.00 D 2030-10-20 Class A Common Stock 233332 933335 D Transaction pursuant to a previously established Rule 10b5-1 Plan. Represents weighted average sales price. The shares were sold at prices ranging from $45.00 to $45.42. The Reporting Person will provide upon request, to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price. Twenty percent (20%) of the shares subject to the option grant vested on October 8, 2021, and the remaining eighty percent (80%) of each such grant vests on a monthly basis for the following four years, so long as the Reporting Person continues to provide services through such vesting dates. Due to rounding in connection with the reverse stock split, the total shares include 2 additional shares that were not originally reported on the Reporting Person's Form 3. /s/ Brady Mickelsen, Attorney-in-Fact 2021-10-14