0000899243-21-049329.txt : 20211221 0000899243-21-049329.hdr.sgml : 20211221 20211221215329 ACCESSION NUMBER: 0000899243-21-049329 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211217 FILED AS OF DATE: 20211221 DATE AS OF CHANGE: 20211221 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Taneja Hemant CENTRAL INDEX KEY: 0001545563 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41140 FILM NUMBER: 211510893 MAIL ADDRESS: STREET 1: 14120 MIRANDA ROAD CITY: LOS ALTOS HILLS STATE: CA ZIP: 94022 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Samsara Inc. CENTRAL INDEX KEY: 0001642896 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373] IRS NUMBER: 473100039 STATE OF INCORPORATION: DE FISCAL YEAR END: 1215 BUSINESS ADDRESS: STREET 1: 1990 ALAMEDA STREET STREET 2: FLOOR 5 CITY: SAN FRANCISCO STATE: CA ZIP: 94103 BUSINESS PHONE: (415) 985-2400 MAIL ADDRESS: STREET 1: 1990 ALAMEDA STREET STREET 2: FLOOR 5 CITY: SAN FRANCISCO STATE: CA ZIP: 94103 FORMER COMPANY: FORMER CONFORMED NAME: Samsara Networks Inc. DATE OF NAME CHANGE: 20150520 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-12-17 0 0001642896 Samsara Inc. IOT 0001545563 Taneja Hemant C/O GENERAL CATALYST PARTNERS 20 UNIVERSITY ROAD, 4TH FLOOR CAMBRIDGE MA 02138 1 0 1 0 Class A Common Stock 2021-12-17 4 P 0 2000000 23.00 A 2000000 I See footnote Series C Preferred Stock 0.00 2021-12-17 4 C 0 21232344 0.00 D Class B Common Stock 21232344 0 I See footnotes Class B Common Stock 0.00 2021-12-17 4 C 0 21232344 0.00 A Class A Common Stock 21232344 21232344 I See footnotes Series D Preferred Stock 0.00 2021-12-17 4 C 0 5001080 0.00 D Class B Common Stock 5001080 0 I See footnotes Class B Common Stock 0.00 2021-12-17 4 C 0 5001080 0.00 A Class A Common Stock 5001080 5001080 I See footnotes Series E Preferred Stock 0.00 2021-12-17 4 C 0 5633880 0.00 D Class B Common Stock 5633880 0 I See footnotes Class B Common Stock 0.00 2021-12-17 4 C 0 5633880 0.00 A Class A Common Stock 5633880 5633880 I See footnotes Series F Preferred Stock 0.00 2021-12-17 4 C 0 13561283 0.00 D Class B Common Stock 13561283 0 I See footnotes Class B Common Stock 0.00 2021-12-17 4 C 0 13561283 0.00 A Class A Common Stock 13561283 13561283 I See footnotes In connection with the Issuer's initial public offering of Class A Common Stock, General Catalyst Group XI-Endurance, L.P. ("GCGXIE") purchased shares of Class A Common Stock from the underwriters at the initial public offering price. General Catalyst Group Management Holdings GP, LLC ("GCGMH LLC") is the general partner of General Catalyst Group Management Holdings, L.P. ("GCGMH"), which is the manager of General Catalyst Group Management, LLC ("GCGM LLC"), which is the manager of General Catalyst Endurance GP XI, LLC, which is the general partner of General Catalyst Partners XI - Endurance, L.P., which is the general partner GCGXIE. Kenneth Chenault, Joel Cutler, David Fialkow and the Reporting Person are managing members of GCGMH LLC, and, as a result, may be deemed to share voting and investment power with respect to the shares held by GCGXIE. Each party named above disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. Each share of Series C Preferred Stock, Series D Preferred Stock, Series E Preferred Stock and Series F Preferred Stock automatically converted into Class B Common Stock on a one-to-one basis immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock. The Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1:1 basis. GCGMH LLC is the general partner of GCGMH, which is the manager of GCGM, LLC, which is (a) the manager of GC Venture VIII Manager, LLC ("GCVVIII Manager"), which is the manager of General Catalyst Group VIII, L.P. ("GCGVIII"), (b) the manager of GC Venture VIII-B Manager, LLC, which is the manager of GC Venture VIII-B, LLC ("GCVVIIIB"), (c) the manager of General Catalyst GP VIII, LLC ("GCGPVIII"), which is the general partner of General Catalyst Partners VIII, L.P., which is the general partner of General Catalyst Group VIII, L.P. ("GCGVIII") and General Catalyst Group VIII Supplemental, L.P. ("GCGVIIIS") and (d) the manager of General Catalyst GP X - Growth Venture LLC, which is the general partner of General Catalyst Partners X - Growth Venture, L.P., which is the general partner of General Catalyst Group X - Endurance, L.P. ("GCGXE"). Kenneth Chenault, Joel Cutler, David Fialkow and the Reporting Person are managing members of GCGMH LLC, and, as a result, may be deemed to share voting and investment power with respect to the shares held by GCVVIII, GCVVIIIB, GCGVIIIS, GCGVIII and GCGXE. Each party named above disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. Consists of 10,616,172 shares held of record by GCGVIIIS and 10,616,172 shares held of record by GCGVIII. Consists of 2,500,540 shares held of record by GCGVIIIS and 2,500,540 shares held of record by GCGVIII. Consists of 3,943,716 shares held of record by GCVVIII, 845,082 shares held of record by GCGVIIIS and 845,082 shares held of record by GCGVIII. Consists of 8,588,813 shares held of record GCGVIII, 226,021 shares held of record by GCGVIIIS, 226,021 shares held of record by GCGVIII and 4,520,428 shares held of record by GCGXE. /s/ Christopher McCain, attorney-in-fact on behalf of Hemant Taneja 2021-12-21