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