UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series B Preferred Stock | Â (1) | Â (1) | Common Stock | 54,054 | $ (1) | D | Â |
Series C Preferred Stock | Â (2) | Â (2) | Common Stock | 17,621 | $ (2) | D | Â |
Right to Buy (Common Stock) (3) | 05/31/2007 | 05/30/2013 | Common Stock | 10,416 | $ 0.36 | D | Â |
Right to Buy (Common Stock) (4) | 05/31/2007 | 11/08/2014 | Common Stock | 9,334 | $ 2.1 | D | Â |
Right to Buy (Common Stock) (5) | 06/07/2008 | 06/03/2015 | Common Stock | 33,333 | $ 2.7 | D | Â |
Right to Buy (Common Stock) (6) | 05/13/2009 | 04/12/2016 | Common Stock | 107,916 | $ 2.7 | D | Â |
Right to Buy (Common Stock) (7) | 09/16/2009 | 12/03/2016 | Common Stock | 117,083 | $ 6.63 | D | Â |
Right to Buy (Common Stock) | Â (8) | 06/11/2017 | Common Stock | 116,650 | $ 14.17 | D | Â |
Right to Buy (Common Stock) (9) | 07/03/2010 | 06/11/2017 | Common Stock | 2,450 | $ 14.17 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Straubel Jeffrey B C/O TESLA MOTORS, INC. 3500 DEER CREEK ROAD PALO ALTO, CA 94304 |
 |  |  Chief Technology Officer |  |
/s/ Jeffrey B. Straubel | 06/25/2010 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Each share of the Issuer's Series B preferred stock will automatically convert into .333333 of a share of common stock upon the closing the Issuer's initial public offering, and has no expiration date. |
(2) | Each share of the Issuer's Series C preferred stock will automatically convert into .350013 of a share of common stock upon the closing the Issuer's initial public offering, and has no expiration date. |
(3) | 1/4th of the shares subject to the option became vested and exercisable on May 31, 2007 and 1/48th of the shares subject to the option shall become vested and exercisable each month thereafter. |
(4) | 1/48th of the shares subject to the option became vested and exercisable on May 31, 2007 and 1/48th of the shares subject to the option shall become vested and exercisable each month thereafter. |
(5) | 1/48th of the shares subject to the option became vested and exercisable on June 7, 2008 and 1/48th of the shares subject to the option shall become vested and exercisable each month thereafter. |
(6) | 1/48th of the shares subject to the option became vested and exercisable on May 13, 2009 and 1/48th of the shares subject to the option shall become vested and exercisable each month thereafter. |
(7) | 1/48th of the shares subject to the option became vested and exercisable on September 16, 2009 and 1/48th of the shares subject to the option shall become vested and exercisable each month thereafter. |
(8) | Shares subject to the option become vested and exercisable upon the Issuer's achievement of certain performance objectives set forth in the option agreement. |
(9) | 1/48th of the shares subject to the option become vested and exercisable on July 3, 2010 and 1/48th of the shares subject to the option shall become vested and exercisable each month thereafter. |
 Remarks: The anticipated effective date of Issuer's initial public offering is June 28, 2010. |