# EDGAR Filing Document

**Accession Number:** 0001031530
**File Stem:** 0001209191-23-007080
**Filing Date:** 2023-2
**Character Count:** 8897
**Document Hash:** 1276f3ecfedbc23b3db544b89946cbdc
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001209191-23-007080.hdr.sgml**: 20230203

**ACCESSION NUMBER**: 0001209191-23-007080

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230201

**FILED AS OF DATE**: 20230203

**DATE AS OF CHANGE**: 20230203

**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:** 23587428

**MAIL ADDRESS:**
- **STREET 1:** SIEBEL SYSTEMS INC
- **STREET 2:** 2207 BRIDGEPOINTE PARKWAY
- **CITY:** SAN MATEO
- **STATE:** CA
- **ZIP:** 94404
**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

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>SIEBEL THOMAS M<br><sub>(Last) (First) (Middle)</sub><br>C/O C3.AI, INC.<br>1300 SEAPORT BLVD, SUITE 500<br><sub>(Street)</sub><br>REDWOOD CITY, CA 94603<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-01 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Chief Executive Officer_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>C3.ai, Inc. [ AI ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Class A Common Stock | 2023-02-01 |  | M |  | 53125 | A | <sup>(1)</sup> | 1809515 | D |  |
| Class A Common Stock | 2023-02-01 |  | F |  | 19625 | D | $21.68 | 1789890 | D |  |
| Class A Common Stock | 2023-02-02 |  | G | V | 33500 | D | $0.00 | 1756390 | D |  |
| Class A Common Stock | 2023-02-02 |  | G | V | 33500 | A | $0.00 | 3583894 | I | See Footnote<sup>(2)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 9216 | I | See Footnote<sup>(3)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 170294 | I | See Footnote<sup>(4)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 72695 | I | See Footnote<sup>(5)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 1237115 | I | See Footnote<sup>(6)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Restricted Stock Units | <sup>(1)</sup> | 2023-02-01 |  | M |  |  | 53125 | <sup>(7)</sup> | <sup>(7)</sup> | Class A Common Stock | 53125 | $0.00 | 690625 | D |  |
| Class B Common Stock | <sup>(8)</sup> | 2022-12-20 |  | G | V |  | 6614<sup>(9)</sup> | <sup>(8)</sup> | <sup>(8)</sup> | Class A Common Stock | 6614 | $0.00 | 0 | I | See Footnote<sup>(10)</sup> |
| Class B Common Stock | <sup>(8)</sup> | 2022-12-20 |  | G | V |  | 6614<sup>(9)</sup> | <sup>(8)</sup> | <sup>(8)</sup> | Class A Common Stock | 6614 | $0.00 | 0 | I | See Footnote<sup>(11)</sup> |
| Class B Common Stock | <sup>(8)</sup> | 2022-12-20 |  | G | V | 13228<sup>(12)</sup> |  | <sup>(8)</sup> | <sup>(8)</sup> | Class A Common Stock | 13228 | $0.00 | 2072820 | I | See Footnote<sup>(2)</sup> |
| Class B Common Stock | <sup>(8)</sup> |  |  |  |  |  |  | <sup>(8)</sup> | <sup>(8)</sup> | Class A Common Stock | 500000 |  | 500000 | I | See Footnote<sup>(3)</sup> |

---

### Footnotes:

(1) Each Restricted Stock Unit (RSU) represents a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement.

(2) The shares are held by The Siebel Living Trust u/a/d 7/27/93, as amended, of which the Reporting Person is trustee.

(3) The shares are held by First Virtual Holdings, LLC, of which the Reporting Person is Chairman.

(4) The shares are held by Siebel Asset Management, L.P., of which the Reporting Person is the general partner.

(5) The shares are held by Siebel Asset Management III, L.P., of which the Reporting Person is the general partner.

(6) The shares are held by The Siebel 2011 Irrevocable Children's Trust, of which the Reporting Person is co-trustee.

(7) 6.25% of each such RSU award vested on August 1, 2022 and 6.25% of each such RSU award shall vest on a quarterly basis thereafter, so long as the Reporting Person continues to provide services through such vesting date.

(8) Each share of Class B Common Stock is convertible at any time at the option of the holder into one share of Class A Common Stock.

(9) On December 22, 2022, shares held by the annuity trust were transferred to The Siebel Living Trust u/a/d 7/27/1993 to satisfy annuity payments.

(10) The shares are held by The Siebel 2020 Annuity Trust III u/a/d 12/3/2020, of which the Reporting Person is the trustee.

(11) The shares are held by The Siebel 2020 Annuity Trust IV u/a/d 12/3/2020, of which the Reporting Person is the trustee.

(12) On December 22, 2022, these shares that were held by the annuity trusts were transferred to The Siebel Living Trust u/a/d 7/27/1993 to satisfy annuity payments.

**Signature:** /s/ Eric Jensen, Attorney-in-Fact  
**Date:** 2023-02-03

### Remarks:

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 4 (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.**