SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
McCall Andy

(Last) (First) (Middle)
C/O SAMSARA INC.
1 DE HARO STREET

(Street)
SAN FRANCISCO CA 94107

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Samsara Inc. [ IOT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
See remarks
3. Date of Earliest Transaction (Month/Day/Year)
09/15/2022
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 09/15/2022 C 106,250 A $0.00 496,099 D
Class A Common Stock 09/15/2022 S(1) 53,539 D $12.1105(2) 442,560 D
Class A Common Stock 09/15/2022 S(1) 12,963 D $12.6255(3) 429,597 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock(4) (5) 09/15/2022 M 106,250 (6) (6) Class B Common Stock 106,250 $0.00 885,417 D
Class B Common Stock $0.00 09/15/2022 M 106,250 (6) (6) Class A Common Stock 106,250 $0.00 1,841,622 D
Class B Common Stock $0.00 09/15/2022 C 106,250 (6) (6) Class A Common Stock 106,250 $0.00 1,735,372 D
Class B Common Stock $0.00 (6) (6) Class A Common Stock 5,399,627 5,399,627 I See footnote(7)
Class B Common Stock $0.00 (6) (6) Class A Common Stock 1,673,333 1,673,333 I See footnote(8)
Class B Common Stock $0.00 (6) (6) Class A Common Stock 646,853 646,853 I See footnote(9)
Class B Common Stock $0.00 (6) (6) Class A Common Stock 646,853 646,853 I See footnote(10)
Explanation of Responses:
1. These shares were disposed of in non-discretionary transactions to cover the reporting person's tax withholding obligations in connection with the settlement of awards of RSUs.
2. The "Amount" and "Price" reported in this Column 4 reflect the aggregate number and weighted-average price, respectively, of shares sold. These shares were sold in multiple transactions at prices ranging from $11.53 to $12.515 inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the SEC staff, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth herein.
3. The "Amount" and "Price" reported in this Column 4 reflect the aggregate number and weighted-average price, respectively, of shares sold. These shares were sold in multiple transactions at prices ranging from $12.56 to $12.68 inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the SEC staff, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth herein.
4. The reported shares are represented by RSUs, of which 106,250 shares vested on September 15, 2022 and the remaining shares vest in quarterly installments through December 15, 2024.
5. Each RSU represents a contingent right to receive one share of Issuer Class B Common Stock.
6. 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.
7. Consists of shares held by JAM and BAM, Co-Trustees of The JAM and BAM Joint Living Trust u/a/d 6/30/2009, over which Mr. McCall has voting or investment power.
8. Consists of shares held by JAM and BAM, Co-Trustees of The McCall 2020 Irrevocable Children's Trust u/a/d 8/7/2020, over which Mr. McCall has voting or investment power.
9. Consists of shares held by James Andrew McCall III, Trustee of The James Andrew McCall III 2020 Annuity Trust u/a/d 8/7/2020, over which Mr. McCall has voting or investment power.
10. Consists of shares held by BAM, Trustee of The BAM 2020 Annuity Trust u/a/d 8/7/2020, over which Mr. McCall has voting or investment power.
Remarks:
Executive Vice President, Chief Revenue Officer
/s/ Adam Eltoukhy, attorney-in-fact on behalf of Andy McCall 09/19/2022
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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