0001685189-19-000004.txt : 20190325
0001685189-19-000004.hdr.sgml : 20190325
20190325202140
ACCESSION NUMBER: 0001685189-19-000004
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190321
FILED AS OF DATE: 20190325
DATE AS OF CHANGE: 20190325
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Madrona Venture Fund IV-A, LP
CENTRAL INDEX KEY: 0001635160
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38464
FILM NUMBER: 19703867
BUSINESS ADDRESS:
STREET 1: 999 THIRD AVE
STREET 2: SUITE 3400
CITY: SEATTLE
STATE: WA
ZIP: 98104
BUSINESS PHONE: 2066743000
MAIL ADDRESS:
STREET 1: 999 THIRD AVE
STREET 2: SUITE 3400
CITY: SEATTLE
STATE: WA
ZIP: 98104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Madrona Venture Fund IV, LP
CENTRAL INDEX KEY: 0001635209
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38464
FILM NUMBER: 19703868
BUSINESS ADDRESS:
STREET 1: 999 THIRD AVE
STREET 2: SUITE 3400
CITY: SEATTLE
STATE: WA
ZIP: 98104
BUSINESS PHONE: 2066743000
MAIL ADDRESS:
STREET 1: 999 THIRD AVE
STREET 2: SUITE 3400
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: 001-38464
FILM NUMBER: 19703869
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: 001-38464
FILM NUMBER: 19703870
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 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: 001-38464
FILM NUMBER: 19703871
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
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: SMARTSHEET INC
CENTRAL INDEX KEY: 0001366561
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 202954357
STATE OF INCORPORATION: WA
FISCAL YEAR END: 0131
BUSINESS ADDRESS:
STREET 1: 10500 NE 8TH STREET
STREET 2: SUITE 1300
CITY: BELLEVUE
STATE: WA
ZIP: 98004
BUSINESS PHONE: 855-420-2395
MAIL ADDRESS:
STREET 1: 10500 NE 8TH STREET
STREET 2: SUITE 1300
CITY: BELLEVUE
STATE: WA
ZIP: 98004
FORMER COMPANY:
FORMER CONFORMED NAME: SMARTSHEET.COM INC
DATE OF NAME CHANGE: 20060619
4
1
wf-form4_155355966320202.xml
FORM 4
X0306
4
2019-03-21
0
0001366561
SMARTSHEET INC
SMAR
0001685189
Madrona Investment Partners III
C/O MADRONA VENTURE GROUP
999 THIRD AVE., 34TH FLOOR
SEATTLE
WA
98104
0
0
1
0
0001333247
Madrona Venture Fund III L P
C/O MADRONA VENTURE GROUP
999 THIRD AVE., 34TH FLOOR
SEATTLE
WA
98104
0
0
1
0
0001333235
Madrona Venture Fund III-A LP
C/O MADRONA VENTURE GROUP
999 THIRD AVE., 34TH FLOOR
SEATTLE
WA
98104
0
0
1
0
0001635209
Madrona Venture Fund IV, LP
C/O MADRONA VENTURE GROUP
999 THIRD AVE., 34TH FLOOR
SEATTLE
WA
98104
0
0
1
0
0001635160
Madrona Venture Fund IV-A, LP
C/O MADRONA VENTURE GROUP
999 THIRD AVE., 34TH FLOOR
SEATTLE
WA
98104
0
0
1
0
Class A Common Stock
2019-03-21
4
C
0
5978560
0
A
5978560
I
By Madrona Venture Fund III, L.P.
Class A Common Stock
2019-03-21
4
J
0
5978560
0
D
0
I
By Madrona Venture Fund III, L.P.
Class A Common Stock
2019-03-21
4
C
0
238836
0
A
238836
I
By Madrona Venture Fund III-A, L.P.
Class A Common Stock
2019-03-21
4
J
0
238836
0
D
0
I
By Madrona Venture Fund III-A, L.P.
Class A Common Stock
2019-03-21
4
C
0
1250728
0
A
1250728
I
By Madrona Venture Fund IV, L.P.
Class A Common Stock
2019-03-21
4
J
0
1250728
0
D
0
I
By Madrona Venture Fund IV, L.P.
Class A Common Stock
2019-03-21
4
C
0
31876
0
A
31876
I
By Madrona Venture Fund IV-A, L.P.
Class A Common Stock
2019-03-21
4
J
0
31876
0
D
0
I
By Madrona Venture Fund IV-A, L.P.
Class B Common Stock
2019-03-21
4
C
0
5978560
0
D
Class A Common Stock
5978560.0
10257237
I
By Madrona Venture Fund III, L.P.
Class B Common Stock
2019-03-21
4
C
0
238836
0
D
Class A Common Stock
238836.0
409756
I
By Madrona Venture Fund III-A,L.P.
Class B Common Stock
2019-03-21
4
C
0
1250728
0
D
Class A Common Stock
1250728.0
2145836
I
By Madrona Venture Fund IV, L.P.
Class B Common Stock
2019-03-21
4
C
0
31876
0
D
Class A Common Stock
31876.0
54687
I
By Madrona Venture Fund IV-A, L.P.
Represents the number of shares that were acquired upon conversion of Class B Common Stock to Class A Common Stock.
These securities are held of record by Madrona Venture Fund III, L.P. ("Madrona III") and Madrona Venture Fund III-A, L.P. ("Madrona III-A"), as applicable. Madrona Investment Partners III, L.P. ("Madrona Partners III") is the general partner of Madrona III and Madrona III-A, and Madrona III General Partner, LLC ("Madrona III LLC") is the general partner of Madrona Partners III. Matthew McIlwain, a member of the issuer's board of directors, together with Tom Alberg, Paul Goodrich, Scott Jacobson, Len Jordon, and Tim Porter, are the managing members of Madrona III LLC, and each may be deemed to share voting and investment power over the securities held by Madrona III and Madrona III-A. Each of such individuals disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and the securities' inclusion herein shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or any other purposes.
The shares reported on this form represent pro rata distributions, and not sales, of securities by the reporting holder to its partners or members of the funds for which it acts as nominee without consideration.
These securities are held of record by Madrona Venture Fund IV, L.P. ("Madrona IV") and Madrona Venture Fund IV-A, L.P. ("Madrona IV-A"), as applicable. Madrona Investment Partners IV, L.P.("Madrona Partners IV") is the general partner of Madrona IV and Madrona IV-A, and Madrona IV General Partner, LLC ("Madrona IV LLC") is the general partner of Madrona Partners IV. Matthew McIlwain, a member of the issuer's board of directors, together with Tom Alberg, Paul Goodrich, Scott Jacobson, Len Jordon, and Tim Porter, are the managing members of Madrona IV LLC, and each may be deemed to share voting and investment power over the securities held by Madrona Fund IV and Madrona Fund IV-A. Each of such individuals disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and the securities' inclusion herein shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or any other purposes.
The Class B Common Stock is convertible into the issuer's Class A Common Stock on a 1-for-1 basis (a) at the option of the holder or (b) automatically upon (i) any transfer, except for certain permitted transfers, or (ii) the date that is the earliest of (x) the date specified by a vote of the holders of not less than a majority of the outstanding shares of Class B Common Stock, (y) April 26, 2025 and (z) the date that the total number of shares of outstanding Class B Common Stock ceases to represent at least 15% of all outstanding shares of the issuer's common stock, and has no expiration date.
/s/ Troy Cichos
Authorized Signatory on behalf of the
Reporting Persons
2019-03-25