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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Baker Hughes Holdings LLC

(Last) (First) (Middle)
17021 ALDINE WESTFIELD

(Street)
HOUSTON TX 77073

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/08/2020
3. Issuer Name and Ticker or Trading Symbol
C3.ai, Inc. [ AI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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)
Class A Common Stock 9,529,762 D(1)
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
Series G Preferred Stock (2) (2) Class A Common Stock 1,283,333 (2) D(1)
1. Name and Address of Reporting Person*
Baker Hughes Holdings LLC

(Last) (First) (Middle)
17021 ALDINE WESTFIELD

(Street)
HOUSTON TX 77073

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
Baker Hughes Co

(Last) (First) (Middle)
17021 ALDINE WESTFIELD

(Street)
HOUSTON TX 77073

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
Simonelli Lorenzo

(Last) (First) (Middle)
C/O BAKER HUGHES COMPANY
17021 ALDINE WESTFIELD

(Street)
HOUSTON TX 77073

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. The reported securities are owned directly by Baker Hughes Holdings LLC ("Holdings"). Holdings is a controlled subsidiary of Baker Hughes Company ("Baker Hughes") and may be deemed to have beneficial ownership of the Class A Common Stock and Series G Preferred Stock held directly by Holdings. Baker Hughes disclaims beneficial ownership of the reported securities except to the extent of their pecuniary interest therein.
2. The Series G Preferred Stock will convert to Class A Common Stock on a 1 for 1 basis upon the closing of the initial public offering of the Issuer.
/s/ Lee Whitley, as Authorized Signatory for Baker Hughes Holdings LLC 12/08/2020
/s/ Lee Whitley, as Authorized Signatory for Baker Hughes Company 12/08/2020
/s/ Lee Whitley, as Attorney-in-Fact for Lorenzo Simonelli 12/08/2020
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.