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 SMARTSHEET INC [ SMAR ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 05/01/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) 05/03/2018 | 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 |
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 | ||||||||
Series F Preferred Stock | (1) | 05/01/2018 | C | 1,748,797 | (1) | (1) | Class B Common Stock(2) | 1,748,797 | $0 | 0(3) | I | See Footnote(4) | |||
Series F Preferred Stock | (1) | 05/01/2018 | C | 769,857 | (1) | (1) | Class B Common Stock(2) | 769,857 | $0 | 0(3) | I | See Footnote(5) | |||
Series F Preferred Stock | (1) | 05/01/2018 | C | 943,187 | (1) | (1) | Class B Common Stock(2) | 943,187 | $0 | 0(3) | I | See Footnote(6) | |||
Series F Preferred Stock | (1) | 05/01/2018 | C | 40,477 | (1) | (1) | Class B Common Stock(2) | 40,477 | $0 | 0(3) | I | See Footnote(7) | |||
Series F Preferred Stock | (1) | 05/01/2018 | C | 110,616 | (1) | (1) | Class B Common Stock(2) | 110,616 | $0 | 0(3) | I | See Footnote(8) | |||
Class B Common Stock | (2) | 05/01/2018 | C | 1,748,797 | (2) | (2) | Class A Common Stock | 1,748,797 | $0 | 13,906,902(3)(9) | I | See Footnote(4) | |||
Class B Common Stock | (2) | 05/01/2018 | C | 769,857 | (2) | (2) | Class A Common Stock | 769,857 | $0 | 6,122,102(3)(9) | I | See Footnote(5) | |||
Class B Common Stock | (2) | 05/01/2018 | C | 943,187 | (2) | (2) | Class A Common Stock | 943,187 | $0 | 7,500,479(3)(9) | I | See Footnote(6) | |||
Class B Common Stock | (2) | 05/01/2018 | C | 40,477 | (2) | (2) | Class A Common Stock | 40,477 | $0 | 321,875(3)(9) | I | See Footnote(7) | |||
Class B Common Stock | (2) | 05/01/2018 | C | 110,616 | (2) | (2) | Class A Common Stock | 110,616 | $0 | 879,649(3)(9) | I | See Footnote(8) |
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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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. The Series F Preferred Stock converted into Class B common stock of the issuer on a one-for-one basis and had no expiration date. |
2. Each share of the issuer's Class B common stock will convert into 1 share of the issuer's Class A common stock (a) at the option of the holder and (b) automatically upon (i) any transfer which occurs after the closing of the issuer's IPO, except for certain permitted transfers, or (ii) the date that is the earliest of (x) the date specified by a vote of the holders of not less than a majority of the outstanding shares of Class B common stock, (y) seven years from the effective date of the IPO and (z) the date that the total number of shares of outstanding Class B common stock ceases to represent at least 15% of all outstanding shares of the issuer's common stock, and has no expiration date. |
3. This amended report is the fifth of five filings made on this 3rd day of July, 2018, to amend a report for transactions that occurred on May 1, 2018. See footnote 10 for a further discussion of such amended report. The amounts reflected in this column (9) are inclusive of the number of derivative securities beneficially owned following the transactions reported across all five filings. |
4. Held directly by Insight Venture Partners VII, L.P. |
5. Held directly by Insight Venture Partners (Cayman) VII, L.P. |
6. Held directly by Insight Venture Partners Coinvestment Fund II, L.P. |
7. Held directly by Insight Venture Partners VII (Co-Investors), L.P. |
8. Held directly by Insight Venture Partners (Delaware) VII, L.P. |
9. On May 3, 2018, the Reporting Persons filed a Form 4 that incorrectly stated in column 9 the number of Class B Common Stock beneficially owned following the reported transactions. |
Remarks: |
Exhibit List Exhibit 99.1 - Joint Filer Information Exhibit 99.2 - Joint Filers' Signatures |
/s/ Insight Holding Group, LLC, by Blair Flicker, its Authorized Signatory | 07/03/2018 | |
** 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. |