0000899243-18-026974.txt : 20181018
0000899243-18-026974.hdr.sgml : 20181018
20181018171052
ACCESSION NUMBER: 0000899243-18-026974
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181016
FILED AS OF DATE: 20181018
DATE AS OF CHANGE: 20181018
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Shasta Ventures II GP, LLC
CENTRAL INDEX KEY: 0001649997
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38698
FILM NUMBER: 181128878
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
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Anaplan, Inc.
CENTRAL INDEX KEY: 0001540755
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 270897861
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 50 HAWTHORNE STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
BUSINESS PHONE: 415-742-8199
MAIL ADDRESS:
STREET 1: 50 HAWTHORNE STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-10-16
0
0001540755
Anaplan, Inc.
PLAN
0001649997
Shasta Ventures II GP, LLC
C/O SHASTA VENTURES
2440 SAND HILL ROAD, SUITE 300
MENLO PARK
CA
94025
0
0
1
0
Common Stock
2018-10-16
4
C
0
13281794
A
13427098
D
Series A Convertible Preferred Stock
2018-10-16
4
C
0
37569
D
Common Stock
37569
0
D
Series B Convertible Preferred Stock
2018-10-16
4
C
0
8876265
D
Common Stock
8876265
0
D
Series C Convertible Preferred Stock
2018-10-16
4
C
0
3136369
D
Common Stock
3136369
0
D
Series D Convertible Preferred Stock
2018-10-16
4
C
0
984044
D
Common Stock
984044
0
D
Series E Convertible Preferred Stock
2018-10-16
4
C
0
247547
D
Common Stock
247547
0
D
The total represents shares received upon conversion of shares of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock, Series D Convertible Preferred Stock and Series E Convertible Preferred Stock.
Shasta Ventures II GP, LLC is the general partner of Shasta Ventures II, L.P. Ravi Mohan, a member of the issuer's Board of Directors, Robert Coneybeer, Tod Francis, and Jason Pressman are the managing members of Shasta Ventures II GP, LLC and each of them may be deemed to exercise voting and investment power over the shares held of record by Shasta Ventures II, L.P. These individuals disclaim beneficial ownership of the shares held by the aforementioned entities except to the extent of any pecuniary interest therein.
The reported security converted into the Issuer's Common Stock on a 1-for-1 basis automatically immediately prior to the closing of the Issuer's initial public offering without payment of further consideration. The shares have no expiration date.
SHASTA VENTURES II GP, LLC, /s/ Suhani Akhare, Attorney-in-Fact
2018-10-18