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