0001209191-22-019897.txt : 20220317
0001209191-22-019897.hdr.sgml : 20220317
20220317210352
ACCESSION NUMBER: 0001209191-22-019897
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220315
FILED AS OF DATE: 20220317
DATE AS OF CHANGE: 20220317
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Chadwick Jonathan
CENTRAL INDEX KEY: 0001375800
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41140
FILM NUMBER: 22750832
MAIL ADDRESS:
STREET 1: 3401 HILLVIEW AVENUE
CITY: PALO ALTO
STATE: CA
ZIP: 94304
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Samsara Inc.
CENTRAL INDEX KEY: 0001642896
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373]
IRS NUMBER: 473100039
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0201
BUSINESS ADDRESS:
STREET 1: 350 RHODE ISLAND STREET
STREET 2: 4TH FLOOR, SOUTH BUILDING
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
BUSINESS PHONE: (415) 985-2400
MAIL ADDRESS:
STREET 1: 350 RHODE ISLAND STREET
STREET 2: 4TH FLOOR, SOUTH BUILDING
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
FORMER COMPANY:
FORMER CONFORMED NAME: Samsara Networks Inc.
DATE OF NAME CHANGE: 20150520
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-03-15
0
0001642896
Samsara Inc.
IOT
0001375800
Chadwick Jonathan
C/O SAMSARA INC., 350 RHODE ISLAND ST.
4TH FLOOR, SOUTH BUILDING
SAN FRANCISCO
CA
94103
1
0
0
0
Class A Common Stock
2022-03-15
4
C
0
30516
0.00
A
30516
D
Class B Common Stock
2022-03-15
4
M
0
183092
0.00
D
Class B Common Stock
183092
305154
D
Class B Common Stock
0.00
2022-03-15
4
M
0
183092
0.00
A
Class A Common Stock
183092
183092
D
Class B Common Stock
0.00
2022-03-15
4
C
0
30516
0.00
D
Class A Common Stock
30516
152576
D
The reported shares are represented by restricted stock units, or RSUs, of which 152,576 vested on December 14, 2021 that were previously reported, 30,516 vested on March 15, 2022 and the remaining shares vest in quarterly installments through September 15, 2024.
Each restricted stock unit, or RSU, represents a contingent right to receive one share of Issuer Class B Common Stock.
The Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1:1 basis.
/s/ Adam Eltoukhy, attorney-in-fact on behalf of Jonathan Chadwick
2022-03-17