Initial Statement of Beneficial Ownership (3)
October 11 2019 - 7:15PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Baglino Andrew D |
2. Date of Event Requiring Statement (MM/DD/YYYY)
10/1/2019
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3. Issuer Name and Ticker or Trading Symbol
Tesla, Inc. [TSLA]
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(Last)
(First)
(Middle)
C/O TESLA, INC., 3500 DEER CREEK ROAD |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) SVP Powertrain and Energy Eng. / |
(Street)
PALO ALTO, CA 94304
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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 | 3654 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Incentive Stock Option (right to buy) | (1) | 1/11/2026 | Common Stock | 979 | $207.85 | D | |
Incentive Stock Option (right to buy) | (2) | 3/19/2028 | Common Stock | 954 | $313.56 | D | |
Incentive Stock Option (right to buy) | (3) | 10/16/2028 | Common Stock | 3 | $276.59 | D | |
Incentive Stock Option (right to buy) | (4) | 7/19/2029 | Common Stock | 387 | $258.18 | D | |
Non-Qualified Stock Option (right to buy) | (5) | 11/10/2024 | Common Stock | 7018 | $241.93 | D | |
Non-Qualified Stock Option (right to buy) | (1) | 1/11/2026 | Common Stock | 9335 | $207.85 | D | |
Non-Qualified Stock Option (right to buy) | (2) | 3/19/2028 | Common Stock | 14046 | $313.56 | D | |
Non-Qualified Stock Option (right to buy) | (3) | 10/16/2028 | Common Stock | 10337 | $276.59 | D | |
Non-Qualified Stock Option (right to buy) | (4) | 7/19/2029 | Common Stock | 41725 | $258.18 | D | |
Restricted Stock Unit | (6) | (6) | Common Stock | 1104 | $0.0 | D | |
Restricted Stock Unit | (7) | (7) | Common Stock | 1847 | $0.0 | D | |
Restricted Stock Unit | (8) | (8) | Common Stock | 2930 | $0.0 | D | |
Explanation of Responses: |
(1) | Represents a single option award grant with respect to 26,479 total shares initially. 1/48th of the total shares subject to the option became vested and exercisable on February 11, 2016 and 1/48th of the shares subject to the option become vested and exercisable on each monthly anniversary thereafter. |
(2) | Represents a single option award grant with respect to 15,000 total shares initially. 1/60th of the total shares subject to the option became vested and exercisable on March 27, 2018 and 1/60th of the shares subject to the option become vested and exercisable on each monthly anniversary thereafter. |
(3) | Represents a single option award grant with respect to 10,340 total shares initially. 1/60th of the total shares subject to the option became vested and exercisable on November 1, 2018 and 1/60th of the shares subject to the option become vested and exercisable on each monthly anniversary thereafter. |
(4) | Represents a single option award grant with respect to 42,112 total shares initially. 1/60th of the total shares subject to the option became vested and exercisable on July 24, 2019 and 1/60th of the shares subject to the option become vested and exercisable on each monthly anniversary thereafter. |
(5) | Shares subject to the option become vested and exercisable upon the Issuer's achievement of certain performance objectives set forth in the option agreement. |
(6) | 1/16th of the total 8,827 restricted stock units initially subject to this award vested on June 5, 2016, and 1/16th of the total units initially subject to this award vest every three months thereafter, so that all such shares subject to this award will be fully vested as of March 5, 2020. |
(7) | 1/16th of the 2,954 total restricted stock units initially subject to this award vested on June 5, 2018, and 1/16th of the total units initially subject to this award vest every three months thereafter, so that all such shares subject to this award will be fully vested as of March 5, 2022. |
(8) | 1/20th of the 3,447 total restricted stock units initially subject to this award vested on March 5, 2019, and 1/20th of the total units initially subject to this award vest every three months thereafter, so that all such shares subject to this award will be fully vested as of December 5, 2023. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Baglino Andrew D C/O TESLA, INC. 3500 DEER CREEK ROAD PALO ALTO, CA 94304 |
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| SVP Powertrain and Energy Eng. |
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Signatures
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By: Aaron Beckman, Power of Attorney For: Andrew D. Baglino | | 10/11/2019 |
**Signature of Reporting Person | Date |
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