0000899243-21-048670.txt : 20211216
0000899243-21-048670.hdr.sgml : 20211216
20211216204827
ACCESSION NUMBER: 0000899243-21-048670
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211214
FILED AS OF DATE: 20211216
DATE AS OF CHANGE: 20211216
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BOSTROM SUSAN L
CENTRAL INDEX KEY: 0001181469
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41140
FILM NUMBER: 211499316
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Samsara Inc.
CENTRAL INDEX KEY: 0001642896
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373]
IRS NUMBER: 473100039
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1215
BUSINESS ADDRESS:
STREET 1: 1990 ALAMEDA STREET
STREET 2: FLOOR 5
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
BUSINESS PHONE: (415) 985-2400
MAIL ADDRESS:
STREET 1: 1990 ALAMEDA STREET
STREET 2: FLOOR 5
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
FORMER COMPANY:
FORMER CONFORMED NAME: Samsara Networks Inc.
DATE OF NAME CHANGE: 20150520
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-12-14
0
0001642896
Samsara Inc.
IOT
0001181469
BOSTROM SUSAN L
C/O SAMSARA INC. 350 RHODE ISLAND STREET
4TH FLOOR, SOUTH BUILDING
SAN FRANCISCO
CA
94103
1
0
0
0
Class B Common Stock
0.00
2021-12-14
4
A
0
240000
0.00
A
Class B Common Stock
240000
240000
D
The reported shares are represented by restricted stock units, or RSUs, that vest as to 1/4 of the total shares subject to the RSU on March 15, 2022 and thereafter on a quarterly basis through March 15, 2025.
The Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1:1 basis.
/s/ Adam Eltoukhy, attorney-in-fact on behalf of Susan L. Bostrom
2021-12-16