FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Apptio Inc [ APTI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 09/28/2016 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Preferred Stock | (1) | 09/28/2016 | C | 1,962,223 | (1) | (1) | Class B Common Stock | 1,962,223 | $0.00 | 0 | I | By Greylock XII Limited Partnership(2) | |||
Series B Preferred Stock | (1) | 09/28/2016 | C | 1,290,276 | (1) | (1) | Class B Common Stock | 1,290,276 | $0.00 | 0 | I | By Greylock XII Limited Partnership(2) | |||
Series C Preferred Stock | (1) | 09/28/2016 | C | 652,431 | (1) | (1) | Class B Common Stock | 652,431 | $0.00 | 0 | I | By Greylock XII Limited Partnership(2) | |||
Series D Preferred Stock | (1) | 09/28/2016 | C | 368,340 | (1) | (1) | Class B Common Stock | 368,340 | $0.00 | 0 | I | By Greylock XII Limited Partnership(2) | |||
Series E Preferred Stock | (1) | 09/28/2016 | C | 134,874 | (1) | (1) | Class B Common Stock | 134,874 | $0.00 | 0 | I | By Greylock XII Limited Partnership(2) | |||
Series A Preferred Stock | (1) | 09/28/2016 | C | 218,026 | (1) | (1) | Class B Common Stock | 218,026 | $0.00 | 0 | I | By Greylock XII-A Limited Partnership(3) | |||
Series B Preferred Stock | (1) | 09/28/2016 | C | 143,364 | (1) | (1) | Class B Common Stock | 143,364 | $0.00 | 0 | I | By Greylock XII-A Limited Partnership(3) | |||
Series C Preferred Stock | (1) | 09/28/2016 | C | 72,492 | (1) | (1) | Class B Common Stock | 72,492 | $0.00 | 0 | I | By Greylock XII-A Limited Partnership(3) | |||
Series D Preferred Stock | (1) | 09/28/2016 | C | 40,926 | (1) | (1) | Class B Common Stock | 40,926 | $0.00 | 0 | I | By Greylock XII-A Limited Partnership(3) | |||
Series E Preferred Stock | (1) | 09/28/2016 | C | 14,985 | (1) | (1) | Class B Common Stock | 14,985 | $0.00 | 0 | I | By Greylock XII-A Limited Partnership(3) | |||
Class B Common Stock | (4) | 09/28/2016 | C | 4,408,144 | (4) | (4) | Class A Common Stock | 4,408,144 | $0.00 | 4,408,144 | I | By Greylock XII Limited Partnership(2) | |||
Class B Common Stock | (4) | 09/28/2016 | C | 489,793 | (4) | (4) | Class A Common Stock | 489,793 | $0.00 | 489,793 | I | By Greylock XII-A Limited Partnership(3) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. The Preferred Stock converted into Class B Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date. |
2. 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. |
3. 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. |
4. Each share of Class B Common Stock is convertible at any time at the option of the Reporting Person into one share of Class A Common Stock and has 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 hereof, (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. |
Remarks: |
/s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP LLC | 09/28/2016 | |
/s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP LLC, the general partner of Greylock XII Limited Partnership | 09/28/2016 | |
/s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP LLC, the general partner of Greylock XII-A Limited Partnership | 09/28/2016 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |