0001209191-18-029660.txt : 20180511
0001209191-18-029660.hdr.sgml : 20180511
20180511181548
ACCESSION NUMBER: 0001209191-18-029660
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180509
FILED AS OF DATE: 20180511
DATE AS OF CHANGE: 20180511
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: 18828212
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: 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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-05-09
0
0001419625
Apptio Inc
APTI
0001192461
MOHAN RAVI
11100 NE 8TH STREET, SUITE 600
BELLEVUE
WA
98004
1
0
0
0
Class A Common Stock
2018-05-09
4
C
0
890917
0.00
A
890917
I
See footnote
Class A Common Stock
2018-05-09
4
J
0
890917
0.00
D
0
I
See footnote
Class A Common Stock
2018-05-09
4
J
0
4961
0.00
A
19238
D
Class B Common Stock
0.00
2018-05-09
4
C
0
890917
0.00
D
Class A Common Stock
890917
0
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.
Represents a pro rata distribution for no consideration to the limited partners of Shasta Ventures, L.P. (the "Distribution").
Acquisition by the reporting person, who is a limited partner of Shasta Ventures, L.P., pursuant to the Distribution.
Includes 8,685 RSUs that represent contingent rights to receive 8,685 shares of the Issuer's Class A Common Stock upon settlement.
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
2018-05-11