SEC Form 4
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*
Bicket John

(Last) (First) (Middle)
C/O SAMSARA INC.
1 DE HARO STREET

(Street)
SAN FRANCISCO CA 94107

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Samsara Inc. [ IOT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
See remarks
3. Date of Earliest Transaction (Month/Day/Year)
05/02/2023
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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
Class A Common Stock 05/02/2023 C 90,295 A $0.00 118,102 I See footnote(1)
Class A Common Stock 05/02/2023 S(2) 90,295 D $17.2522(3) 27,807 I See footnote(1)
Class A Common Stock 355,572(4) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Class B Common Stock $0.00 05/02/2023 C 90,295 (5) (5) Class A Common Stock 90,295 $0.00 85,822,510 I See footnote(1)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 152,564 152,564 D
Class B Common Stock $0.00 (5) (5) Class A Common Stock 1,283,986 1,283,986 I See footnote(6)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 790,328 790,328 I See footnote(7)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 17,312,164 17,312,164 I See footnote(8)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 790,328 790,328 I See footnote(9)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 1,286,597 1,286,597 I See footnote(10)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 4,466,764 4,466,764 I See footnote(11)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 250,000 250,000 I See footnote(12)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 250,000 250,000 I See footnote(13)
Class B Common Stock $0.00 (5) (5) Class A Common Stock 250,000 250,000 I See footnote(14)
Explanation of Responses:
1. Consists of shares held by John C. Bicket, Trustee of the John C. Bicket Revocable Trust u/a/d 2/15/2013, over which the Reporting Person has voting or investment power.
2. The sales reported by the Reporting Person were effected pursuant to a Rule 10b5-1 trading plan, entered into prior to the effectiveness of the revised requirements of Rule 10b5-1(c). In compliance with SEC guidance, the Reporting Person has not checked the box above but states that the Rule 10b5-1 trading plan is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c).
3. The "Amount" and "Price" reported in this Column 4 reflect the aggregate number and weighted-average price, respectively, of shares sold. These shares were sold in multiple transactions at prices ranging from $17.02 to $17.87, inclusive. The Reporting Person undertakes to provide to the issuer, any security holder of the issuer, or the SEC staff, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth herein.
4. Certain of these securities are restricted stock units (RSUs). Each RSU represents a contingent right to receive one share of Class A Common Stock, subject to the applicable vesting schedule and conditions of each RSU.
5. 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.
6. Consists of shares held by John C. Bicket and CBD, Co-Trustees of the Bicket-Dobson Revocable Trust u/a/d 12/23/20, over which the Reporting Person has voting or investment power.
7. Consists of shares held by John C. Bicket, Trustee of the John C. Bicket 2023 Annuity Trust u/a/d 1/22/2023, over which the Reporting Person has voting or investment power.
8. Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust II u/a/d 10/8/2021, over which the Reporting Person has voting or investment power.
9. Consists of shares held by CBD, Trustee of the CBD 2023 Annuity Trust u/a/d 1/22/2023, over which the Reporting Person has voting or investment power.
10. Consists of shares held by the Reporting Person's spouse.
11. Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust I u/a/d 11/10/2021, over which the Reporting Person has voting or investment power.
12. Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust I-A fbo ACDB u/a/d 11/10/2021, over which the Reporting Person has voting or investment power.
13. Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust I-A fbo JCDB u/a/d 11/10/2021, over which the Reporting Person has voting or investment power.
14. Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust I-A u/a/d 11/10/2021, over which the Reporting Person has voting or investment power.
Remarks:
Executive Vice President, Chief Technology Officer
/s/ Adam Eltoukhy, attorney-in-fact on behalf of John Bicket 05/04/2023
** 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.
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