SEC Form 4 · accession 0000899243-18-026970

Anaplan, Inc. · PLAN

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

Reporting owner

Director · 10% Owner

Period of report

Oct 16, 2018

Accepted (ET)

Oct 18, 2018 · 5:05 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001540755

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F3,F2	Oct 16, 2018	C	13,281,794	—	A	13,427,098	I	By Shasta Ventures II, L.P.

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series A Convertible Preferred Stock^F3,F2	—	Oct 16, 2018	C	37,569	D	—	—	Common Stock	37,569	I
Series B Convertible Preferred Stock^F3,F2	—	Oct 16, 2018	C	8,876,265	D	—	—	Common Stock	8,876,265	I
Series C Convertible Preferred Stock^F3,F2	—	Oct 16, 2018	C	3,136,369	D	—	—	Common Stock	3,136,369	I
Series D Convertible Preferred Stock^F3,F2	—	Oct 16, 2018	C	984,044	D	—	—	Common Stock	984,044	I
Series E Convertible Preferred Stock^F3,F2	—	Oct 16, 2018	C	247,547	D	—	—	Common Stock	247,547	I

F1The total represents shares received upon conversion of shares of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock, Series D Convertible Preferred Stock and Series E Convertible Preferred Stock.
F2Shasta Ventures II GP, LLC is the general partner of Shasta Ventures II, L.P. Ravi Mohan, a member of the issuer's Board of Directors, Robert Coneybeer, Tod Francis, and Jason Pressman are the managing members of Shasta Ventures II GP, LLC and each of them may be deemed to exercise voting and investment power over the shares held of record by Shasta Ventures II, L.P. These individuals disclaim beneficial ownership of the shares held by the aforementioned entities except to the extent of any pecuniary interest therein.
F3The reported security converted into the Issuer's Common Stock on a 1-for-1 basis automatically immediately prior to the closing of the Issuer's initial public offering without payment of further consideration. The shares have no expiration date.