0000899243-21-048665.txt : 20211216 0000899243-21-048665.hdr.sgml : 20211216 20211216204551 ACCESSION NUMBER: 0000899243-21-048665 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211214 FILED AS OF DATE: 20211216 DATE AS OF CHANGE: 20211216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Phillips Dominic CENTRAL INDEX KEY: 0001895148 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41140 FILM NUMBER: 211499309 MAIL ADDRESS: STREET 1: 350 RHODE ISLAND STREET STREET 2: 4TH FLOOR, SOUTH BUILDING CITY: SAN FRANCISCO STATE: CA ZIP: 94103 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 2021-12-14 0 0001642896 Samsara Inc. IOT 0001895148 Phillips Dominic C/O SAMSARA INC. 350 RHODE ISLAND STREET 4TH FLOOR, SOUTH BUILDING SAN FRANCISCO CA 94103 0 1 0 0 See remarks Class A Common Stock 2021-12-14 4 C 0 2410023 0.00 A 2410023 D Class B Common Stock 0.00 2021-12-14 4 A 0 2804368 0.00 A Class B Common Stock 2804368 2804368 D Class B Common Stock 0.00 2021-12-14 4 F 0 394345 0.00 D Class A Common Stock 394345 2410023 D Class B Common Stock 0.00 2021-12-14 4 C 0 2410023 0.00 D Class A Common Stock 2410023 0 D The reported shares are represented by restricted stock units, or RSUs, of which 1,243,956 vested upon the effectiveness of the Issuer's registration statement in connection with its initial public offering of Class A Common Stock and the remaining shares vest as follows: (i) 885,900 vest in quarterly installments beginning on March 15, 2022 through December 15, 2023, (ii) 245,036 vest in quarterly installments beginning on March 15, 2022 through December 15, 2023 and (iii) 429,476 vest in quarterly installments beginning on March 15, 2022 through March 15, 2025. 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. In an exempt disposition to the Issuer under Rule 16b-3(e), the Reporting Person remitted shares to the Issuer in connection with the satisfaction of tax withholding obligations arising out of the vesting of RSUs. Executive Vice President, Chief Financial Officer /s/ Adam Eltoukhy, attorney-in-fact on behalf of Dominic Phillips 2021-12-16