0001381752-20-000006.txt : 20200609
0001381752-20-000006.hdr.sgml : 20200609
20200609202144
ACCESSION NUMBER: 0001381752-20-000006
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200605
FILED AS OF DATE: 20200609
DATE AS OF CHANGE: 20200609
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: 20953269
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_159174848476394.xml
FORM 4
X0306
4
2020-06-05
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
2020-06-05
4
J
0
1149892
0
D
0
I
By Madrona Venture Fund III, L.P.
Class A Common Stock
2020-06-05
4
J
0
45934
0
D
0
I
By Madrona Venture Fund III-A, L.P.
Class A Common Stock
2020-06-05
4
J
0
240560
0
D
0
I
By Madrona Venture Fund IV, L.P.
Class A Common Stock
2020-06-05
4
J
0
6130
0
D
0
I
By Madrona Venture Fund IV-A, L.P.
Class A Common Stock
2020-06-05
4
J
0
44688
0
A
169556
D
The shares reported on this form represent pro rata distributions, and not sales or purchases, of securities by the reporting entity to its partners or members or the funds for which it acts as nominee without consideration.
These securities are held of record by Madrona Venture Fund III, L.P ("Madrona Fund III") and Madrona Venture Fund III-A, L.P. ("Madrona Fund III-A") as applicable. Madrona Investment Partners III, L.P. ("Madrona Partners III") is the general partner of Madrona Fund III and Madrona Fund III-A. 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 may be deemed to share voting and investment power over securities held by Madrona Fund III and Madrona Fund III-A. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and such securities' inclusion shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or other purposes.
These securities are held of record by Madrona Venture Fund IV, L.P ("Madrona Fund IV") and Madrona Venture Fund IV-A, L.P. ("Madrona Fund IV-A") as applicable. Madrona Investment Partners IV, L.P. ("Madrona Partners IV-A") is the general partner of Madrona Fund IV and Madrona Fund IV-A. 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 may be deemed to share voting and investment power over securities held by Madrona Fund IV and Madrona Fund IV-A. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and such securities' inclusion shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or other purposes.
/s/ Paul Porrini as attorney-in-fact for Matthew McIlwain
2020-06-09