0000899243-16-030232.txt : 20160928 0000899243-16-030232.hdr.sgml : 20160928 20160928163021 ACCESSION NUMBER: 0000899243-16-030232 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160928 FILED AS OF DATE: 20160928 DATE AS OF CHANGE: 20160928 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McIlwain Matthew S CENTRAL INDEX KEY: 0001381752 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37885 FILM NUMBER: 161907267 MAIL ADDRESS: STREET 1: 1000 SECOND AVENUE STREET 2: SUITE 3700 CITY: SEATTLE STATE: WA ZIP: 98104 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-09-28 0 0001419625 Apptio Inc APTI 0001381752 McIlwain Matthew S 999 THIRD AVENUE, 34TH FLOOR SEATTLE WA 98104 1 0 1 0 Series A Preferred Stock 2016-09-28 4 C 0 2295000 0.00 D Class B Common Stock 2295000 0 I See footnote Series B Preferred Stock 2016-09-28 4 C 0 1509095 0.00 D Class B Common Stock 1509095 0 I See footnote Series C Preferred Stock 2016-09-28 4 C 0 763076 0.00 D Class B Common Stock 763076 0 I See footnote Series D Preferred Stock 2016-09-28 4 C 0 430806 0.00 D Class B Common Stock 430806 0 I See footnote Series E Preferred Stock 2016-09-28 4 C 0 201809 0.00 D Class B Common Stock 201809 0 I See footnote Class B Common Stock 2016-09-28 4 C 0 5199786 0.00 A Class A Common Stock 5199786 5199786 I See footnotes Includes 2,206,839 shares held by Madrona Venture Fund III, L.P.("Madrona III") and 88,161 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. Mr. McIlwain disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. Includes 1,451,124 shares held by Madrona III and 57,971 shares held by Madrona III-A. Mr. McIlwain disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. Includes 733,763 shares held by Madrona III and 29,313 shares held by Madrona III-A. Mr. McIlwain disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. Includes 414,257 shares held by Madrona III and 16,549 shares held by Madrona III-A. Mr. McIlwain disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. Includes 194,057 shares held by Madrona III and 7,752 shares held by Madrona III-A. Mr. McIlwain disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. The Preferred Stock converted into Class B Common Stock on a 1-for-1 basis immediately prior to the closing of the issuer's initial public offering and had no expiration date. 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. /s/ John Morrow, attorney-in-fact 2016-09-28