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