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