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