0001381752-19-000021.txt : 20190923
0001381752-19-000021.hdr.sgml : 20190923
20190923195310
ACCESSION NUMBER: 0001381752-19-000021
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: McIlwain Matthew S
CENTRAL INDEX KEY: 0001381752
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38464
FILM NUMBER: 191109019
MAIL ADDRESS:
STREET 1: 1000 SECOND AVENUE
STREET 2: SUITE 3700
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_156928277385986.xml
FORM 4
X0306
4
2019-09-19
0
0001366561
SMARTSHEET INC
SMAR
0001381752
McIlwain Matthew S
C/O MADRONA VENTURE GROUP
999 THIRD AVE., 34TH FLOOR
SEATTLE
WA
98104
1
0
0
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 A Common Stock
166818
D
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. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and such 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 IV and Madrona IV-A. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and such 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/ Paul Porrini as attorney-in-fact for Matthew McIlwain
2019-09-23