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*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Anaplan, Inc. [ PLAN ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 06/05/2019 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 | ||||||
Common Stock | 06/05/2019 | J(1) | 22,453 | A | (1) | 126,030 | D | |||
Common Stock | 06/05/2019 | J(2) | 126,030 | D | (2) | 0 | D | |||
Common Stock | 06/05/2019 | J(2) | 99,947 | D | (2) | 0 | I | By Granite Ventures Entrepreneurs Fund II, L.P.(3) | ||
Common Stock | 06/05/2019 | J(2) | 1,500,000 | D | (2) | 10,851,794 | I | By Granite Ventures II, L.P.(3) | ||
Common Stock | 06/05/2019 | J(2) | 250,036 | D | (2) | 0 | I | By GV Anaplan SPV, L.P.(3) | ||
Common Stock | 06/05/2019 | J(1) | 51,354 | A | (1) | 55,354 | D(4) | |||
Common Stock | 06/05/2019 | J(1) | 29,580 | A | (1) | 29,580 | I | By Trust(5) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. Represents an acquisition of securities from an in-kind distribution, and not a purchase or sale, without additional consideration paid, and is therefore an exempt, non-matchable acquisition pursuant to Section 16(b). |
2. Represents a pro-rata in-kind distribution, and not a purchase or sale, without additional consideration to its partners. |
3. Granite Management II, LLC is the general partner of Granite Ventures II, L.P. and Granite Ventures Entrepreneurs Fund II, L.P. Granite Ventures, LLC is the general partner of GV Anaplan SPV, L.P. Standish O'Grady, a member of our board of directors, Jacqueline Berterretche and Christopher McKay are managing directors of the general partner entities of these funds that directly hold shares and as such Mr. O'Grady, Ms. Berterreche and Mr. McKay may be deemed to have voting and investment power with respect to such shares. These individuals disclaim beneficial ownership of the shares held by the aforementioned entities except to the extent of any pecuniary interest therein. |
4. Represents shares held directly by Christopher McKay. |
5. Represents shares held by the Dominic and Jacqueline Berterretche Revocable Trust. |
Remarks: |
GRANITE MANAGEMENT II, LLC, By Granite Ventures, LLC, Its Managing Member, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche Title: Member | 06/06/2019 | |
GRANITE VENTURES, LLC, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche, Title: Member | 06/06/2019 | |
GRANITE VENTURES II, L.P., By Granite Management II, LLC, Its General Partner, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche, Title: Member | 06/06/2019 | |
GRANITE VENTURES ENTREPRENEURS FUND II, L.P., By Granite Management II, LLC, Its General Partner, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche, Title: Member | 06/06/2019 | |
GV ANAPLAN SPV, L.P. By Granite Ventures, LLC, Its General Partner, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche, Title: Member | 06/06/2019 | |
By /s/ Jacqueline Berterretche, Jacqueline Berterretche | 06/06/2019 | |
By /s/ Christopher McKay, Christopher McKay | 06/06/2019 | |
** 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |