0000899243-16-029759.txt : 20160922 0000899243-16-029759.hdr.sgml : 20160922 20160922173623 ACCESSION NUMBER: 0000899243-16-029759 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160922 FILED AS OF DATE: 20160922 DATE AS OF CHANGE: 20160922 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Apptio Inc CENTRAL INDEX KEY: 0001419625 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 261175252 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 11100 NE 8TH STREET STREET 2: SUITE 600 CITY: BELLEVUE STATE: WA ZIP: 98004 BUSINESS PHONE: 425-453-5861 MAIL ADDRESS: STREET 1: 11100 NE 8TH STREET STREET 2: SUITE 600 CITY: BELLEVUE STATE: WA ZIP: 98004 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Greylock XII-A Limited Partnership CENTRAL INDEX KEY: 0001496057 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37885 FILM NUMBER: 161898293 BUSINESS ADDRESS: STREET 1: 40 GROVE STREET STREET 2: SUITE 430 CITY: WELLESLEY STATE: MA ZIP: 02482 BUSINESS PHONE: 781-622-2200 MAIL ADDRESS: STREET 1: 40 GROVE STREET STREET 2: SUITE 430 CITY: WELLESLEY STATE: MA ZIP: 02482 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Greylock XII Limited Partnership CENTRAL INDEX KEY: 0001413950 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37885 FILM NUMBER: 161898294 BUSINESS ADDRESS: STREET 1: 40 GROVE STREET STREET 2: SUITE 430 CITY: WELLESLEY STATE: MA ZIP: 02482 BUSINESS PHONE: 781-622-2200 MAIL ADDRESS: STREET 1: 40 GROVE STREET STREET 2: SUITE 430 CITY: WELLESLEY STATE: MA ZIP: 02482 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Greylock XII GP LLC CENTRAL INDEX KEY: 0001413877 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37885 FILM NUMBER: 161898295 BUSINESS ADDRESS: STREET 1: 40 GROVE STREET STREET 2: SUITE 430 CITY: WELLESLEY STATE: MA ZIP: 02482 BUSINESS PHONE: 781-622-2200 MAIL ADDRESS: STREET 1: 40 GROVE STREET STREET 2: SUITE 430 CITY: WELLESLEY STATE: MA ZIP: 02482 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2016-09-22 0 0001419625 Apptio Inc APTI 0001413877 Greylock XII GP LLC 2550 SAND HILL ROAD, SUITE 200 MENLO PARK CA 94025 0 0 1 0 0001413950 Greylock XII Limited Partnership 2550 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001496057 Greylock XII-A Limited Partnership 2550 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 Series A Preferred Stock Class B Common Stock 1962223 I By Greylock XII Limited Partnership Series B Preferred Stock Class B Common Stock 1290276 I By Greylock XII Limited Partnership Series C Preferred Stock Class B Common Stock 652431 I By Greylock XII Limited Partnership Series D Preferred Stock Class B Common Stock 368340 I By Greylock XII Limited Partnership Series E Preferred Stock Class B Common Stock 134874 I By Greylock XII Limited Partnership Series A Preferred Stock Class B Common Stock 218026 I By Greylock XII-A Limited Partnership Series B Preferred Stock Class B Common Stock 143364 I By Greylock XII-A Limited Partnership Series C Preferred Stock Class B Common Stock 72492 I By Greylock XII-A Limited Partnership Series D Preferred Stock Class B Common Stock 40926 I By Greylock XII-A Limited Partnership Series E Preferred Stock Class B Common Stock 14985 I By Greylock XII-A Limited Partnership These shares of Preferred Stock have no expiration date or conversion price and will automatically convert to shares of the Issuer's Class B Common Stock immediately prior to the closing of the Issuer's initial public offering on a 1-for-1 basis. The shares are held directly by Greylock XII Limited Partnership ("Greylock XII LP"). Greylock XII GP Limited Liability Company ("Greylock XII GP") is the sole General Partner of Greylock XII LP and may be deemed to share voting and dispositive power with respect to the shares held by Greylock XII LP. Greylock XII GP disclaims beneficial ownership of the securities held by Greylock XII LP except to the extent of any pecuniary interest therein and the inclusion of these securities in this report shall not be deemed an admission by Greylock XII GP of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. The shares are held directly by Greylock XII-A Limited Partnership ("Greylock XII-A LP"). Greylock XII GP is the sole General Partner of Greylock XII-A LP and may be deemed to share voting and dispositive power with respect to the shares held by Greylock XII-A LP. Greylock XII GP disclaims any beneficial ownership of the securities held by Greylock XII-A LP except to the extent of any pecuniary interest therein and the inclusion of these securities in this report shall not be deemed an admission by Greylock XII GP of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. Each share of Class B Common Stock will be convertible at any time at the option of the Reporting Person into one share of Class A Common Stock and will have no expiration date. The Class B Common Stock will convert automatically into Class A Common Stock on the same basis upon the earlier of: (i) any transfer, whether or not for value, except for certain transfers to "Permitted Transferees" as defined in the Issuer's restated certificate of incorporation in effect as of the date of the closing of the Issuer's initial public offering, (ii) the date on which the Class B Common Stock ceases to represent at least 25% of the Issuer's outstanding common stock, or (iii) the seventh anniversary of the closing of the Issuer's initial public offering. /s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP LLC 2016-09-22 /s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP LLC, the general partner of Greylock XII Limited Partnership 2016-09-22 /s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP LLC, the general partner of Greylock XII-A Limited Partnership 2016-09-22