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