SEC Form 4 · accession 0000899243-16-030209

Apptio Inc · APTI

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owners

Greylock XII GP LLC

10% Owner

Greylock XII Limited Partnership

10% Owner

Greylock XII-A Limited Partnership

10% Owner

Period of report

Sep 28, 2016

Accepted (ET)

Sep 28, 2016 · 12:42 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001419625

Table I — non-derivative securities

No Table I lines on this filing.

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series A Preferred Stock^F2,F1	—	Sep 28, 2016	C	1,962,223	D	—	—	Class B Common Stock	1,962,223	0	I
Series B Preferred Stock^F2,F1	—	Sep 28, 2016	C	1,290,276	D	—	—	Class B Common Stock	1,290,276	0	I
Series C Preferred Stock^F2,F1	—	Sep 28, 2016	C	652,431	D	—	—	Class B Common Stock	652,431	0	I
Series D Preferred Stock^F2,F1	—	Sep 28, 2016	C	368,340	D	—	—	Class B Common Stock	368,340	0	I
Series E Preferred Stock^F2,F1	—	Sep 28, 2016	C	134,874	D	—	—	Class B Common Stock	134,874	0	I
Series A Preferred Stock^F3,F1	—	Sep 28, 2016	C	218,026	D	—	—	Class B Common Stock	218,026	0	I
Series B Preferred Stock^F3,F1	—	Sep 28, 2016	C	143,364	D	—	—	Class B Common Stock	143,364	0	I
Series C Preferred Stock^F3,F1	—	Sep 28, 2016	C	72,492	D	—	—	Class B Common Stock	72,492	0	I
Series D Preferred Stock^F3,F1	—	Sep 28, 2016	C	40,926	D	—	—	Class B Common Stock	40,926	0	I
Series E Preferred Stock^F3,F1	—	Sep 28, 2016	C	14,985	D	—	—	Class B Common Stock	14,985	0	I
Class B Common Stock^F2,F4	—	Sep 28, 2016	C	4,408,144	A	—	—	Class A Common Stock	4,408,144	4,408,144	I
Class B Common Stock^F3,F4	—	Sep 28, 2016	C	489,793	A	—	—	Class A Common Stock	489,793	489,793	I

Explanation of responses

F1The 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.
F2The 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.
F3The 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.
F4Each 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.