0001209191-18-008560.txt : 20180208
0001209191-18-008560.hdr.sgml : 20180208
20180208183712
ACCESSION NUMBER: 0001209191-18-008560
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180206
FILED AS OF DATE: 20180208
DATE AS OF CHANGE: 20180208
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Madrona Venture Fund III L P
CENTRAL INDEX KEY: 0001333247
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37885
FILM NUMBER: 18587031
BUSINESS ADDRESS:
STREET 1: 1000 SECOND AVE
STREET 2: SUITE 3700
CITY: SEATTLE
STATE: WA
ZIP: 98104
BUSINESS PHONE: 2066743000
MAIL ADDRESS:
STREET 1: 1000 SECOND AVE
STREET 2: SUITE 3700
CITY: SEATTLE
STATE: WA
ZIP: 98104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Madrona Venture Fund III-A LP
CENTRAL INDEX KEY: 0001333235
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37885
FILM NUMBER: 18587030
BUSINESS ADDRESS:
STREET 1: 1000 SECOND AVE
STREET 2: SUITE 3700
CITY: SEATTLE
STATE: WA
ZIP: 98104
BUSINESS PHONE: 2066743000
MAIL ADDRESS:
STREET 1: 1000 SECOND AVE
STREET 2: SUITE 3700
CITY: SEATTLE
STATE: WA
ZIP: 98104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Madrona Investment Partners III
CENTRAL INDEX KEY: 0001685189
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37885
FILM NUMBER: 18587029
BUSINESS ADDRESS:
STREET 1: 999 THIRD AVE
STREET 2: 34TH FLOOR
CITY: SEATTLE
STATE: WA
ZIP: 98104
BUSINESS PHONE: 206-674-6329
MAIL ADDRESS:
STREET 1: 999 THIRD AVE
STREET 2: 34TH FLOOR
CITY: SEATTLE
STATE: WA
ZIP: 98104
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Apptio Inc
CENTRAL INDEX KEY: 0001419625
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 261175252
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 11100 NE 8TH STREET
STREET 2: SUITE 600
CITY: BELLEVUE
STATE: WA
ZIP: 98004
BUSINESS PHONE: 425-453-5861
MAIL ADDRESS:
STREET 1: 11100 NE 8TH STREET
STREET 2: SUITE 600
CITY: BELLEVUE
STATE: WA
ZIP: 98004
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-02-06
1
0001419625
Apptio Inc
APTI
0001333247
Madrona Venture Fund III L P
999 THIRD AVENUE, 34TH FLOOR
SEATTLE
WA
98104
0
0
0
1
Former 10% Owner
0001333235
Madrona Venture Fund III-A LP
999 THIRD AVENUE, 34TH FLOOR
SEATTLE
WA
98104
0
0
0
1
Former 10% Owner
0001685189
Madrona Investment Partners III
999 THIRD AVENUE, 34TH FLOOR
SEATTLE
WA
98104
0
0
0
1
Former 10% Owner
Class A Common Stock
2018-02-06
4
C
0
2000000
0.00
A
2000000
I
See footnote
Class A Common Stock
2018-02-06
4
J
0
2000000
0.00
D
0
I
See footnote
Class B Common Stock
0.00
2018-02-06
4
C
0
2000000
0.00
D
Class A Common Stock
2000000
2049786
I
See footnote
Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the reporting persons.
Includes 1,923,172 shares held by Madrona Venture Fund III, L.P. ("Madrona III") and 76,828 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.
Represents a pro rata distribution for no consideration to the limited partners and general partners of Madrona III and Madrona III-A.
Class 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.
Includes 1,971,044 shares held by Madrona III and 78,742 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.
/s/ Frederick Williams, attorney-in-fact
2018-02-08