0001415889-24-007379.txt : 20240308 0001415889-24-007379.hdr.sgml : 20240308 20240308170100 ACCESSION NUMBER: 0001415889-24-007379 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240306 FILED AS OF DATE: 20240308 DATE AS OF CHANGE: 20240308 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Phillips Dominic CENTRAL INDEX KEY: 0001895148 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41140 FILM NUMBER: 24735350 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] ORGANIZATION NAME: 06 Technology IRS NUMBER: 473100039 STATE OF INCORPORATION: DE FISCAL YEAR END: 0203 BUSINESS ADDRESS: STREET 1: 1 DE HARO STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94107 BUSINESS PHONE: (415) 985-2400 MAIL ADDRESS: STREET 1: 1 DE HARO STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94107 FORMER COMPANY: FORMER CONFORMED NAME: Samsara Networks Inc. DATE OF NAME CHANGE: 20150520 4 1 form4-03082024_100331.xml X0508 4 2024-03-06 0001642896 Samsara Inc. IOT 0001895148 Phillips Dominic C/O SAMSARA INC. 1 DE HARO STREET SAN FRANCISCO CA 94107 false true false false SEE REMARKS 0 Class A Common Stock 2024-03-06 4 A 0 591715 0 A 1264915 D Class A Common Stock 1061816 I See footnote Class A Common Stock 4 I See footnote These securities are restricted stock units (RSUs). Each RSU represents a contingent right to receive one share of Class A Common Stock. One-sixteenth of the RSUs shall vest on March 15, 2024 and each quarterly vesting date thereafter, subject to the Reporting Person continuing as a service provider through each such date. The number of shares held reflects the transfer, of 1,061,816 shares of Class A Common Stock from the Reporting Person to The Phillips Family Trust dated 5/9/201, of which the Reporting Person and his spouse serve as trustees (the "Phillips Family Trust"). Certain of these securities are RSUs. Each RSU represents a contingent right to receive one share of Class A Common Stock, subject to the applicable vesting schedule and conditions of each RSU. Consists of shares held by the Phillips Family Trust. Consists of shares held by the Reporting Person's children. Executive Vice President, Chief Financial Officer /s/ Adam Eltoukhy, attorney-in-fact on behalf of Dominic Phillips 2024-03-08