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3 Form - Initial statement of beneficial ownership of securities - Baglino Andrew D (0001790565) (Reporting)

SEC FORM 3SEC Form 3
FORM 3UNITED 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*
Baglino Andrew D

(Last)(First)(Middle)
C/O TESLA, INC.
3500 DEER CREEK ROAD

(Street)
PALO ALTOCA94304

(City)(State)(Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/01/2019
3. Issuer Name and Ticker or Trading Symbol
Tesla, Inc. [ TSLA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director10% Owner
XOfficer (give title below)Other (specify below)
SVP Powertrain and Energy Eng.
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
XForm 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 Stock3,654D
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 ExercisableExpiration DateTitleAmount or Number of Shares
Incentive Stock Option (right to buy) (1)01/11/2026Common Stock979207.85D
Incentive Stock Option (right to buy) (2)03/19/2028Common Stock954313.56D
Incentive Stock Option (right to buy) (3)10/16/2028Common Stock3276.59D
Incentive Stock Option (right to buy) (4)07/19/2029Common Stock387258.18D
Non-Qualified Stock Option (right to buy) (5)11/10/2024Common Stock7,018241.93D
Non-Qualified Stock Option (right to buy) (1)01/11/2026Common Stock9,335207.85D
Non-Qualified Stock Option (right to buy) (2)03/19/2028Common Stock14,046313.56D
Non-Qualified Stock Option (right to buy) (3)10/16/2028Common Stock10,337276.59D
Non-Qualified Stock Option (right to buy) (4)07/19/2029Common Stock41,725258.18D
Restricted Stock Unit (6) (6)Common Stock1,1040.0D
Restricted Stock Unit (7) (7)Common Stock1,8470.0D
Restricted Stock Unit (8) (8)Common Stock2,9300.0D
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.
By: Aaron Beckman, Power of Attorney For: Andrew D. Baglino10/11/2019
** Signature of Reporting PersonDate
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.