SEC Form 4 · accession 0000899243-16-030230

Apptio Inc · APTI

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

Reporting owner

Director

Period of report

Sep 28, 2016

Accepted (ET)

Sep 28, 2016 · 4:30 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.

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series A Preferred Stock^F1,F2	—	Sep 28, 2016	C	182,143	D	—	—	Class B Common Stock	182,143	0	I
Series B Preferred Stock^F1,F2	—	Sep 28, 2016	C	1,509,095	D	—	—	Class B Common Stock	1,509,095	0	I
Series C Preferred Stock^F1,F2	—	Sep 28, 2016	C	1,044,211	D	—	—	Class B Common Stock	1,044,211	0	I
Series D Preferred Stock^F1,F2	—	Sep 28, 2016	C	223,253	D	—	—	Class B Common Stock	223,253	0	I
Series E Preferred Stock^F1,F2	—	Sep 28, 2016	C	11,022	D	—	—	Class B Common Stock	11,022	0	I
Class B Common Stock^F1,F3	—	Sep 28, 2016	C	2,969,724	A	—	—	Class A Common Stock	2,969,724	2,969,724	I

F1These shares are held by Shasta Ventures, L.P. Shasta Ventures GP, LLC is the general partner of Shasta Ventures, L.P. Mr. Mohan is a managing member of Shasta Ventures GP, LLC. Mr. Mohan disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein.
F2The Preferred Stock automatically converted into the issuer's 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.
F3Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1-for-1 basis and has no expiration date.