SEC Form 4 · accession 0000899243-17-011236
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
Apr 28, 2017
Accepted (ET)
Apr 28, 2017 · 7:30 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001419625
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class A Common StockF1,F3 | Apr 28, 2017 | C | 4,408,144 | $0.00 | A | 4,408,144 | I | By Greylock XII Limited Partnership |
| Class A Common StockF2,F4 | Apr 28, 2017 | C | 489,793 | $0.00 | A | 489,793 | I | By Greylock XII-A Limited Partnership |
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,F5 | — | Apr 28, 2017 | C | 4,408,144 | A | — | — | Class A Common Stock | 4,408,144 | 4,408,144 | I |
| Class B Common StockF4,F5 | — | Apr 28, 2017 | C | 489,793 | A | — | — | Class A Common Stock | 489,793 | 489,793 | I |
Explanation of responses
- F1Represents the conversion of 4,408,144 shares of Class B Common Stock into 4,408,144 shares of Class A Common Stock.
- F2Represents the conversion of 489,793 shares of Class B Common Stock into 489,793 shares of Class A Common Stock.
- F3The 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.
- F4The shares are held directly by Greylock XII-A Limited Partnership ("Greylock XII-A LP"). Greylock XII GP Limited Liability Company ("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 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.
- F5Each 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.