0001685189-19-000008.txt : 20190923
0001685189-19-000008.hdr.sgml : 20190923
20190923195201
ACCESSION NUMBER: 0001685189-19-000008
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190919
FILED AS OF DATE: 20190923
DATE AS OF CHANGE: 20190923
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: 191109014
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 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: 191109015
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-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: 191109016
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 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: 191109017
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-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: 191109018
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
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_156928270464537.xml
FORM 4
X0306
4
2019-09-19
1
0001366561
SMARTSHEET INC
SMAR
0001685189
Madrona Investment Partners III
C/O MADRONA VENTURE GROUP
999 THIRD AVE., 34TH FLOOR
SEATTLE
WA
98104
0
0
0
1
Former 10% Owner
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
2019-09-19
4
C
0
6132030
A
6132030
I
By Madrona Venture Fund III, L.P.
Class A Common Stock
2019-09-19
4
C
0
244959
A
244959
I
By Madrona Venture Fund III-A, L.P.
Class A Common Stock
2019-09-19
4
C
0
1282835
A
1282835
I
By Madrona Venture Fund IV, L.P.
Class A Common Stock
2019-09-19
4
C
0
32692
A
32692
I
By Madrona Venture Fund IV-A, L.P.
Class B Common Stock
2019-09-19
4
C
0
6132030
0
D
Class A Common Stock
6132030.0
0
I
By Madrona Venture Fund III, L.P.
Class B Common Stock
2019-09-19
4
C
0
244959
0
D
Class A Common Stock
244959.0
0
I
By Madrona Venture Fund III-A,L.P.
Class B Common Stock
2019-09-19
4
C
0
1282835
0
D
Class A Common Stock
1282835.0
0
I
By Madrona Venture Fund IV, L.P.
Class B Common Stock
2019-09-19
4
C
0
32692
0
D
Class A Common Stock
32692.0
0
I
By Madrona Venture Fund IV-A, L.P.
Does not represent a sale or purchase of the issuer's common stock but the automatic conversion of shares of the issuer's Class B Common Stock into shares of the issuer's Class A Common Stock effective as of the date that the total number of shares of outstanding Class B Common Stock ceased to represent at least 15% of all outstanding shares of the issuer's common stock, as set forth in the issuer's Amended and Restated Articles of Incorporation.
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.
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.
/s/ Troy Cichos
Authorized Signatory on behalf of the
Reporting Persons
2019-09-23