0001209191-17-059505.txt : 20171106 0001209191-17-059505.hdr.sgml : 20171106 20171106185903 ACCESSION NUMBER: 0001209191-17-059505 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171103 FILED AS OF DATE: 20171106 DATE AS OF CHANGE: 20171106 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MOHAN RAVI CENTRAL INDEX KEY: 0001192461 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37885 FILM NUMBER: 171180729 MAIL ADDRESS: STREET 1: C/O SHASTA VENTURES STREET 2: 2440 SAND HILL ROAD, SUITE 300 CITY: MENLO PARK STATE: CA ZIP: 94025 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 2017-11-03 0 0001419625 Apptio Inc APTI 0001192461 MOHAN RAVI 11100 NE 8TH STREET, SUITE 600 BELLEVUE WA 98004 1 0 0 0 Class A Common Stock 2017-11-03 4 C 0 890917 0.00 A 890917 I See footnote Class A Common Stock 2017-11-03 4 J 0 890917 0.00 D 0 I See footnote Class A Common Stock 2017-11-03 4 J 0 2396 0.00 A 12679 D Class B Common Stock 0.00 2017-11-03 4 C 0 890917 0.00 D Class A Common Stock 890917 1484862 I See footnote These shares are held by Shasta Ventures, L.P. Shasta Ventures GP, LLC is the general partner of Shasta Ventures, L.P. Mr. Mohan is a managing member of Shasta Ventures GP, LLC. Mr. Mohan disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. Represents a pro rata distribution for no consideration to the limited partners of Shasta Ventures, L.P. (the "Distribution"). Acquisition by the reporting person, who is a limited partner of Shasta Ventures, L.P., pursuant to the Distribution. Includes 8,685 RSUs that represent contingent rights to receive 8,685 shares of the Issuer's Class A Common Stock upon settlement. 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/ Frederick Williams, attorney-in-fact 2017-11-06