0001209191-22-038149.txt : 20220617
0001209191-22-038149.hdr.sgml : 20220617
20220617192758
ACCESSION NUMBER: 0001209191-22-038149
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220615
FILED AS OF DATE: 20220617
DATE AS OF CHANGE: 20220617
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: 221025570
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: 0128
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
2022-06-15
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
2022-06-15
4
C
0
30515
0.00
A
61031
D
Class B Common Stock
2022-06-15
4
M
0
30515
0.00
D
Class B Common Stock
30515
274639
D
Class B Common Stock
0.00
2022-06-15
4
M
0
30515
0.00
A
Class A Common Stock
30515
183091
D
Class B Common Stock
0.00
2022-06-15
4
C
0
30515
0.00
D
Class A Common Stock
30515
152576
D
The reported shares are represented by restricted stock units, or RSUs, of which 30,515 vested on June 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
2022-06-17