0001415889-24-012486.txt : 20240507
0001415889-24-012486.hdr.sgml : 20240507
20240507170025
ACCESSION NUMBER: 0001415889-24-012486
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240503
FILED AS OF DATE: 20240507
DATE AS OF CHANGE: 20240507
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LIVERMORE ANN M
CENTRAL INDEX KEY: 0001207622
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41140
FILM NUMBER: 24922988
MAIL ADDRESS:
STREET 1: C/O HEWLETT PACKARD ENTERPRISE CO
STREET 2: 1701 E MOSSY OAKS ROAD
CITY: SPRING
STATE: TX
ZIP: 77389
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Samsara Inc.
CENTRAL INDEX KEY: 0001642896
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373]
ORGANIZATION NAME: 06 Technology
IRS NUMBER: 473100039
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0203
BUSINESS ADDRESS:
STREET 1: 1 DE HARO STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: (415) 985-2400
MAIL ADDRESS:
STREET 1: 1 DE HARO STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
FORMER COMPANY:
FORMER CONFORMED NAME: Samsara Networks Inc.
DATE OF NAME CHANGE: 20150520
4
1
form4-05072024_090519.xml
X0508
4
2024-05-03
0001642896
Samsara Inc.
IOT
0001207622
LIVERMORE ANN M
C/O SAMSARA INC.
1 DE HARO STREET
SAN FRANCISCO
CA
94107
true
false
false
false
0
Class A Common Stock
2024-05-03
4
C
0
137498
0
A
161552
D
Class A Common Stock
2024-05-03
4
C
0
62502
0
A
224054
D
Class B Common Stock
0
2024-05-03
4
C
0
137498
0
D
Class A Common Stock
137498
0
D
Class B Common Stock
2024-05-03
4
C
0
62502
0
D
Class A Common Stock
62502
0
D
Certain of these securities are restricted stock units (RSUs). Each RSU represents a contingent right to receive one share of Class A Common Stock, subject to the applicable vesting schedule and conditions of each RSU.
The Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1:1 basis.
The reported securities represent RSUs, which were to be settled for shares of Class B Common Stock, and have been modified at the Reporting Person's election to be settled for shares of Class A Common Stock.
Each RSU represents a contingent right to receive one share of Class B Common Stock.
/s/ Adam Eltoukhy, attorney-in-fact on behalf of Ann M. Livermore
2024-05-07