SEC Form 4 · accession 0001200925-19-000006
SMARTSHEET INC · SMAR
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Patrick Mader
Officer — President and CEO · Director
Period of report
Sep 14, 2018
Accepted (ET)
Jan 11, 2019 · 9:56 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001366561
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class A Common StockF1,F2 | Sep 14, 2018 | C | 159,814 | $0.00 | A | 159,814 | I | By father-in-law |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class B Common StockF3,F2,F4 | — | Sep 14, 2018 | C | 159,814 | D | — | — | Class A Common Stock | 159,814 | 0 | I |
| Class B Common StockF3 | — | holding | — | — | — | — | — | Class A Common Stock | 1,419,254 | 1,419,254 | D |
| Class B Common StockF3,F5 | — | holding | — | — | — | — | — | Class A Common Stock | 126,250 | 126,250 | I |
| Class B Common StockF3,F5 | — | holding | — | — | — | — | — | Class A Common Stock | 126,250 | 126,250 | I |
Explanation of responses
- F1Represents the number of shares that were acquired upon conversion of Class B Common Stock to Class A Common Stock.
- F2The reporting person disclaims beneficial ownership over such securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
- F3Each share of the issuer's Class B Common Stock will convert into 1 share of the issuer's Class A Common Stock (a) at the option of the holder or (b) automatically upon (i) any transfer which occurs after the closing of the issuer's initial public offering ("IPO"), except for certain permitted transfers, and (ii) the date that is the earliest of (x) the date specified by a vote of the holders of not less than a majority of the outstanding shares of Class B Common Stock, (y) seven years from the effective date of the IPO and (z) the date that the total number of shares of outstanding Class B Common Stock ceases to represent at least 15% of all outstanding shares of the issuer's common stock, and has no expiration date.
- F4The holder elected to convert the Class B common stock to Class A common stock on a 1-for-1 basis.
- F5These securities are held of record by Douglas Porter, Trustee of each of the T77A Trust and the T49C Trust, trusts for the benefit of the reporting person's children. The reporting person disclaims beneficial ownership over such securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.