0000899243-16-030230.txt : 20160928
0000899243-16-030230.hdr.sgml : 20160928
20160928163018
ACCESSION NUMBER: 0000899243-16-030230
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160928
FILED AS OF DATE: 20160928
DATE AS OF CHANGE: 20160928
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37885
FILM NUMBER: 161907265
MAIL ADDRESS:
STREET 1: C/O SHASTA VENTURES
STREET 2: 2440 SAND HILL ROAD, SUITE 300
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-09-28
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
2016-09-28
4
C
0
182143
0.00
D
Class B Common Stock
182143
0
I
See footnote
Series B Preferred Stock
2016-09-28
4
C
0
1509095
0.00
D
Class B Common Stock
1509095
0
I
See footnote
Series C Preferred Stock
2016-09-28
4
C
0
1044211
0.00
D
Class B Common Stock
1044211
0
I
See footnote
Series D Preferred Stock
2016-09-28
4
C
0
223253
0.00
D
Class B Common Stock
223253
0
I
See footnote
Series E Preferred Stock
2016-09-28
4
C
0
11022
0.00
D
Class B Common Stock
11022
0
I
See footnote
Class B Common Stock
2016-09-28
4
C
0
2969724
0.00
A
Class A Common Stock
2969724
2969724
I
See footnote
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.
The Preferred Stock automatically converted into the issuer's Class B Common Stock on a 1-for-1 basis immediately prior to the closing of the issuer's initial public offering and had no expiration date.
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.
/s/ John Morrow, attorney-in-fact
2016-09-28