0000899243-16-029805.txt : 20160922 0000899243-16-029805.hdr.sgml : 20160922 20160922203034 ACCESSION NUMBER: 0000899243-16-029805 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20160922 FILED AS OF DATE: 20160922 DATE AS OF CHANGE: 20160922 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Apptio Inc CENTRAL INDEX KEY: 0001419625 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 261175252 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 11100 NE 8TH STREET STREET 2: SUITE 600 CITY: BELLEVUE STATE: WA ZIP: 98004 BUSINESS PHONE: 425-453-5861 MAIL ADDRESS: STREET 1: 11100 NE 8TH STREET STREET 2: SUITE 600 CITY: BELLEVUE STATE: WA ZIP: 98004 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MOHAN RAVI CENTRAL INDEX KEY: 0001192461 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37885 FILM NUMBER: 161898541 MAIL ADDRESS: STREET 1: C/O SHASTA VENTURES STREET 2: 2440 SAND HILL ROAD, SUITE 300 CITY: MENLO PARK STATE: CA ZIP: 94025 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2016-09-22 0 0001419625 Apptio Inc APTI 0001192461 MOHAN RAVI 11100 NE 8TH STREET, SUITE 600 BELLEVUE WA 98004 1 0 0 0 Series A Preferred Stock Class B Common Stock 182143 I See footnote Series B Preferred Stock Class B Common Stock 1509095 I See footnote Series C Preferred Stock Class B Common Stock 1044211 I See footnote Series D Preferred Stock Class B Common Stock 223253 I See footnote Series E Preferred Stock Class B Common Stock 11022 I See footnote Stock Option (right to buy) 14.31 2025-11-05 Class B Common Stock 30000 D These shares are held by Shasta Ventures, L.P. Shasta Ventures GP, LLC is the general partner of Shasta Ventures, L.P. Mr. Mohan is a managing member of Shasta Ventures GP, LLC. Mr. Mohan disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. These shares of Preferred Stock have no expiration date or conversion price and will automatically convert to shares of the issuer's Class B Common Stock immediately prior to the closing of the issuer's initial public offering on a 1-for-1 basis. 1/3rd of the shares subject to the option shall become vested on September 29, 2017 and 1/36th of the shares subject to the option shall vest monthly thereafter for the next 24 months. The option is subject to an early exercise right and may be exercised in full prior to the vesting of the shares underlying the option, subject to the issuer's right of repurchase. Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1-for-1 basis and has no expiration date. John Morrow, attorney-in-fact 2016-09-22 EX-24 2 attachment1.htm EX-24 DOCUMENT

                               POWER OF ATTORNEY

     The undersigned, as a Section 16 reporting person of Apptio, Inc. (the
"Company"), hereby constitutes and appoints John Morrow, Todd Smith, Frederick
Williams and Jered Fahey as the undersigned's true and lawful attorneys-in-fact,
to:

     1.   Prepare, execute in the undersigned's name and on the undersigned's
          behalf, and submit to the Securities and Exchange Commission (the
          "SEC") a Form ID, including amendments thereto, and any other
          documents necessary or appropriate to obtain EDGAR codes and passwords
          enabling the undersigned to make electronic filings with the SEC of
          reports required by Section 16(a) of the Securities Exchange Act of
          1934 or any rule or regulation of the SEC;

     2.   Complete and execute Forms 3, 4 and 5 and other forms and all
          amendments thereto as such attorneys-in-fact shall in their discretion
          determine to be required or advisable pursuant to Section 16 of the
          Securities Exchange Act of 1934 (as amended) and the rules and
          regulations promulgated thereunder, or any successor laws and
          regulations, as a consequence of the undersigned's ownership,
          acquisition or disposition of securities of the Company;

     3.   Complete and execute Forms 144 and other forms and all amendments
          thereto as such attorneys-in-fact shall in their discretion determine
          to be required or advisable pursuant to Rule 144 of the Securities Act
          of 1933 (as amended), and the rules and regulations promulgated
          thereunder, or any successor laws and regulations, as a consequence of
          the undersigned's disposition of securities of the Company; and

     4.   Do all acts necessary in order to file any such Forms 3, 4, 5, or 144
          with the SEC, any securities exchange or national association, the
          Company and such other person or agency as the attorneys-in-fact shall
          deem appropriate.

     The undersigned hereby ratifies and confirms all that said
attorneys-in-fact and agent shall do or cause to be done by virtue hereof. The
undersigned acknowledges that the foregoing attorneys-in-fact, in serving in
such capacity at the request of the undersigned, are not assuming, nor is the
Company assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934 (as amended).

     This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, 5 and 144 with respect to
the undersigned's holdings of and transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing delivered
to the Company and the foregoing attorneys-in-fact.

     IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of 9/12/16.

                                        Signature:  /s/ Ravi Mohan
                                                    ----------------------------
                                                    Name: Ravi Mohan
                                                    Title: Director