SEC Form 4 · accession 0001209191-17-062173
Apptio Inc · APTI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Madrona Venture Fund III-A LP
10% Owner
Madrona Venture Fund III L P
10% Owner
Madrona Investment Partners III
10% Owner
Period of report
Nov 17, 2017
Accepted (ET)
Nov 21, 2017 · 6:34 pm EST
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 StockF2 | Nov 17, 2017 | C | 1,150,000 | $0.00 | A | 1,150,000 | I | See footnote |
| Class A Common StockF2 | Nov 17, 2017 | J | 1,150,000 | $0.00 | D | 0 | I | See footnote |
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 StockF2,F5,F4 | $0.00 | Nov 17, 2017 | C | 1,150,000 | D | — | — | Class A Common Stock | 1,150,000 | 4,049,786 | I |
Explanation of responses
- F1Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the reporting persons.
- F2Includes 1,105,824 shares held by Madrona Venture Fund III, L.P. ("Madrona III") and 44,176 shares held by Madrona Venture Fund III-A, L.P. ("Madrona III-A"). Matthew McIlwain (who is a director of the issuer and files separate section 16(a) reports) is a Managing Director of the various entities affiliated with Madrona. Madrona Investment Partners III, L.P. is the general partner of Madrona III and Madrona III-A. Each of the Filing Persons disclaims beneficial ownership of the shares except to the extent of his or its pecuniary interest therein.
- F3Represents a pro rata distribution for no consideration to the limited partners and general partners of Madrona III and Madrona III-A.
- F4Class 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.
- F5Includes 3,894,216 shares held by Madrona III and 155,570 shares held Madrona III-A. Each of the Filing Persons disclaims beneficial ownership of the shares except to the extent of his or its pecuniary interest therein.