0000899243-16-030234.txt : 20160928
0000899243-16-030234.hdr.sgml : 20160928
20160928163101
ACCESSION NUMBER: 0000899243-16-030234
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160928
FILED AS OF DATE: 20160928
DATE AS OF CHANGE: 20160928
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Madrona Investment Partners III
CENTRAL INDEX KEY: 0001685189
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37885
FILM NUMBER: 161907277
BUSINESS ADDRESS:
STREET 1: 999 THIRD AVE
STREET 2: 34TH FLOOR
CITY: SEATTLE
STATE: WA
ZIP: 98104
BUSINESS PHONE: 206-674-6329
MAIL ADDRESS:
STREET 1: 999 THIRD AVE
STREET 2: 34TH FLOOR
CITY: SEATTLE
STATE: WA
ZIP: 98104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Madrona Venture Fund III-A LP
CENTRAL INDEX KEY: 0001333235
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37885
FILM NUMBER: 161907278
BUSINESS ADDRESS:
STREET 1: 1000 SECOND AVE
STREET 2: SUITE 3700
CITY: SEATTLE
STATE: WA
ZIP: 98104
BUSINESS PHONE: 2066743000
MAIL ADDRESS:
STREET 1: 1000 SECOND AVE
STREET 2: SUITE 3700
CITY: SEATTLE
STATE: WA
ZIP: 98104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Madrona Venture Fund III L P
CENTRAL INDEX KEY: 0001333247
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37885
FILM NUMBER: 161907279
BUSINESS ADDRESS:
STREET 1: 1000 SECOND AVE
STREET 2: SUITE 3700
CITY: SEATTLE
STATE: WA
ZIP: 98104
BUSINESS PHONE: 2066743000
MAIL ADDRESS:
STREET 1: 1000 SECOND AVE
STREET 2: SUITE 3700
CITY: SEATTLE
STATE: WA
ZIP: 98104
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-09-28
0
0001419625
Apptio Inc
APTI
0001333247
Madrona Venture Fund III L P
999 THIRD AVENUE, 34TH FLOOR
SEATTLE
WA
98104
0
0
1
0
0001333235
Madrona Venture Fund III-A LP
999 THIRD AVENUE, 34TH FLOOR
SEATTLE
WA
98104
0
0
1
0
0001685189
Madrona Investment Partners III
999 THIRD AVENUE, 34TH FLOOR
SEATTLE
WA
98104
0
0
1
0
Series A Preferred Stock
2016-09-28
4
C
0
2295000
0.00
D
Class B Common Stock
2295000
0
I
See footnote
Series B Preferred Stock
2016-09-28
4
C
0
1509095
0.00
D
Class B Common Stock
1509095
0
I
See footnote
Series C Preferred Stock
2016-09-28
4
C
0
763076
0.00
D
Class B Common Stock
763076
0
I
See footnote
Series D Preferred Stock
2016-09-28
4
C
0
430806
0.00
D
Class B Common Stock
430806
0
I
See footnote
Series E Preferred Stock
2016-09-28
4
C
0
201809
0.00
D
Class B Common Stock
201809
0
I
See footnote
Class B Common Stock
2016-09-28
4
C
0
5199786
0.00
A
Class A Common Stock
5199786
5199786
I
See footnotes
Includes 2,206,839 shares held by Madrona Venture Fund III, L.P.("Madrona III") and 88,161 shares held by Madrona Venture Fund III-A, L.P. ("Madrona III-A"). Matthew McIlwain (who is a director of the issuer and files separate section 16(a) reports) is a Managing Director of the various entities affiliated with Madrona. Madrona Investment Partners III, L.P. is the general partner of Madrona III and Madrona III-A. Each of the Filing Persons disclaims beneficial ownership of the shares except to the extent of his or its pecuniary interest therein.
Includes 1,451,124 shares held by Madrona III and 57,971 shares held by Madrona III-A. Each of the Filing Persons disclaims beneficial ownership of the shares except to the extent of his or its pecuniary interest therein.
Includes 733,763 shares held by Madrona III and 29,313 shares held by Madrona III-A. Each of the Filing Persons disclaims beneficial ownership of the shares except to the extent of his or its pecuniary interest therein.
Includes 414,257 shares held by Madrona III and 16,549 shares held by Madrona III-A. Each of the Filing Persons disclaims beneficial ownership of the shares except to the extent of his or its pecuniary interest therein.
Includes 194,057 shares held by Madrona III and 7,752 shares held by Madrona III-A. Each of the Filing Persons disclaims beneficial ownership of the shares except to the extent of his or its pecuniary interest therein.
The Preferred Stock converted into Class B Common Stock on a 1-for1 basis immediately prior to the closing of the issuer's initial public offering and had no expiration date.
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, as attorney-in-fact for Madrona Venture Fund III, L.P.
2016-09-28
/s/ John Morrow, as attorney-in-fact for Madrona Venture Fund III-A, L.P.
2016-09-28
/s/ John Morrow, as attorney-in-fact for Madrona Investment Partners III, L.P.
2016-09-28