0001209191-17-062621.txt : 20171127
0001209191-17-062621.hdr.sgml : 20171127
20171127181813
ACCESSION NUMBER: 0001209191-17-062621
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171127
FILED AS OF DATE: 20171127
DATE AS OF CHANGE: 20171127
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MOTT DAVID M
CENTRAL INDEX KEY: 0001219871
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38098
FILM NUMBER: 171223796
MAIL ADDRESS:
STREET 1: 1119 ST. PAUL STREET
CITY: BALTIMORE
STATE: MD
ZIP: 21202
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: APPIAN CORP
CENTRAL INDEX KEY: 0001441683
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 541956084
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 11955 DEMOCRACY DRIVE
STREET 2: SUITE 1700
CITY: RESTON
STATE: VA
ZIP: 20190
BUSINESS PHONE: 703-442-8844
MAIL ADDRESS:
STREET 1: 11955 DEMOCRACY DRIVE
STREET 2: SUITE 1700
CITY: RESTON
STATE: VA
ZIP: 20190
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-11-27
0
0001441683
APPIAN CORP
APPN
0001219871
MOTT DAVID M
1954 GREENSPRING DRIVE
SUITE 600
TIMONIUM
MD
21093
0
0
1
0
Class A Common Stock
2017-11-27
4
C
0
569620
A
569620
I
See Note 4
Class A Common Stock
2017-11-27
4
S
0
569620
19.49
D
0
I
See Note 4
Class B Common Stock
2017-11-27
4
C
0
569620
0.00
D
Class A Common Stock
569620
2724202
I
See Note 4
Pursuant to the terms of the Class B Common Stock, New Enterprise Associates 14, L.P. ("NEA 14") converted shares of Class B Common Stock into shares of Class A Common Stock.
Each share of Class B Common Stock is convertible at any time at the option of the holder into one share of Class A Common Stock and has no
expiration date. In addition, each share of Class B Common Stock will convert automatically into one share of Class A Common Stock upon (1)
any transfer, whether or not for value and whether voluntary or involuntary or by operation of law, except for certain transfers described in the
Issuer's certificate of incorporation, including, without limitation, certain transfers for tax and estate planning purposes or (continued to Footnote (3))
(continued from Footnote (2)) (2) the death or disability, as defined in the Issuer's certificate of incorporation, of the applicable Class B common
stockholder (or nine months after the date of death or disability if the stockholder is one of the Issuer's founders). In addition, on the first trading day following the date on which the outstanding shares of Class B Common Stock represent less than 10% of the aggregate voting power of the
Issuer's then outstanding capital stock, all outstanding shares of Class B Common Stock shall convert automatically into Class A Common Stock,
and no additional shares of Class B Common Stock will be issued.
The Reporting Person is a director of NEA 14 GP, LTD, which is the sole general partner of NEA Partners 14, L.P. ("NEA Partners 14"). NEA Partners 14 is the sole general partner of NEA 14, which is the direct beneficial owner of the securities. The Reporting Person disclaims beneficial ownership, within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the NEA 14 shares in which the Reporting Person has no pecuniary interest.
/s/ Sasha Keough, attorney-in-fact
2017-11-27