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