0000899243-19-015213.txt : 20190530 0000899243-19-015213.hdr.sgml : 20190530 20190530190137 ACCESSION NUMBER: 0000899243-19-015213 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190528 FILED AS OF DATE: 20190530 DATE AS OF CHANGE: 20190530 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: 001-38698 FILM NUMBER: 19868070 MAIL ADDRESS: STREET 1: C/O SHASTA VENTURES STREET 2: 2440 SAND HILL ROAD, SUITE 300 CITY: MENLO PARK STATE: CA ZIP: 94025 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Anaplan, Inc. CENTRAL INDEX KEY: 0001540755 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 270897861 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 50 HAWTHORNE STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94105 BUSINESS PHONE: 415-742-8199 MAIL ADDRESS: STREET 1: 50 HAWTHORNE STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94105 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-05-28 0 0001540755 Anaplan, Inc. PLAN 0001192461 MOHAN RAVI 2440 SAND HILL ROAD, SUITE 300 MENLO PARK CA 94025 1 0 0 0 Common Stock 2019-05-28 4 J 0 3400000 D 10027098 I By Shasta Ventures II, L.P. Common Stock 2019-05-28 4 J 0 707200 A 707200 I Shasta Ventures II GP, LLC Common Stock 2019-05-28 4 J 0 690200 D 17000 I Shasta Ventures II GP, LLC Common Stock 2019-05-28 4 J 0 149257 A 149257 D Represents an in kind distribution without consideration by Shasta Ventures II, L.P. ("Shasta II") to its partners, including its general partner, Shasta Ventures II GP, LLC ("Shasta II GP"). These shares are owned directly by Shasta II, of which Shasta II GP is the sole general partner and exercises voting and investment power over these shares. The reporting person is a managing director of Shasta II and disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose. Represents the receipt of shares in the pro rata in kind distribution of Common Stock of the Issuer by Shasta II described in footnote (1). These shares are owned directly by Shasta II GP. The reporting person is a managing director of Shasta II and disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose. Represents a pro-rata in-kind distribution of shares by Shasta II GP, without consideration, to its members. Represents a change in the form of ownership from indirect ownership to direct by virtue of the receipt of shares in the pro rata in kind distribution by Shasta II GP described in footnote (5). /s/ Ravi Mohan 2019-05-30