0000899243-17-011238.txt : 20170428 0000899243-17-011238.hdr.sgml : 20170428 20170428194844 ACCESSION NUMBER: 0000899243-17-011238 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170428 FILED AS OF DATE: 20170428 DATE AS OF CHANGE: 20170428 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: Shasta Ventures GP, LLC CENTRAL INDEX KEY: 0001649998 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37885 FILM NUMBER: 17798063 BUSINESS ADDRESS: STREET 1: 2440 SAND HILL ROAD, SUITE 300 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650 543 1700 MAIL ADDRESS: STREET 1: 2440 SAND HILL ROAD, SUITE 300 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shasta Ventures, L.P. CENTRAL INDEX KEY: 0001308845 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37885 FILM NUMBER: 17798064 BUSINESS ADDRESS: STREET 1: C/O SHASTA VENTURES STREET 2: 2440 SAND HILL ROAD, SUITE 300 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650 543 1700 MAIL ADDRESS: STREET 1: C/O SHASTA VENTURES STREET 2: 2440 SAND HILL ROAD, SUITE 300 CITY: MENLO PARK STATE: CA ZIP: 94025 FORMER NAME: FORMER CONFORMED NAME: Shasta Ventures LP DATE OF NAME CHANGE: 20041116 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2017-04-28 0 0001419625 Apptio Inc APTI 0001308845 Shasta Ventures, L.P. 2440 SAND HILL ROAD, SUITE 300 MENLO PARK CA 94025 0 0 1 0 0001649998 Shasta Ventures GP, LLC 2440 SAND HILL ROAD, SUITE 300 MENLO PARK CA 94025 0 0 1 0 Class B Common Stock 0.00 Class A Common Stock 2969724 D 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. Shasta Ventures GP, LLC is the general partner of Shasta Ventures, L.P. Ravi Mohan, a member of the issuer's board of directors, Tod Francis and Robert Coneybeer are the managing members of Shasta Ventures GP, LLC and each of them may be deemed to exercise voting and investment power over the shares held of record by Shasta Ventures, L.P. Each of the foregoing individuals disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. Based on the Form 10-K/A filed by the issuer with the Securities and Exchange Commission on April 28, 2017, Shasta Ventures, L.P. beneficially owns in excess of 10% of the Issuer's Class B common stock. /s/ Fred Williams, as attorney-in-fact for Shasta Ventures, GP, LLC, the General Partner of Shasta Ventures, L.P. 2017-04-28 /s/ Fred Williams, as attorney-in-fact for Shasta Ventures, GP, LLC 2017-04-28