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 Apptio Inc [ APTI ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 03/12/2018 | ||||||||||||||||||||||||||
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 | ||||||
Class A Common Stock | 03/12/2018 | C(1) | 65,858 | A | $0.00 | 65,858 | I | See footnote(2) | ||
Class A Common Stock | 03/12/2018 | G(3) | V | 65,858 | D | $0.00 | 0 | I | See footnote(2) | |
Class A Common Stock | 03/12/2018 | C(1) | 65,858 | A | $0.00 | 65,858 | I | See footnote(4) | ||
Class A Common Stock | 03/12/2018 | G(3) | V | 65,858 | D | $0.00 | 0 | I | See footnote(4) |
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 | ||||||||
Class B Common Stock | $0.00(5) | 03/12/2018 | C | 65,858 | (5) | (5) | Class A Common Stock | 65,858(6) | $0.00 | 0 | I | See footnote(2) | |||
Class B Common Stock | $0.00(5) | 03/12/2018 | C | 65,858 | (5) | (5) | Class A Common Stock | 65,858(7) | $0.00 | 0 | I | See footnote(4) | |||
Class B Common Stock | $0.00(5) | (5) | (5) | Class A Common Stock | 789,757 | 789,757(8) | D | ||||||||
Class B Common Stock | $0.00(5) | (5) | (5) | Class A Common Stock | 34,142 | 34,142(9) | I | See footnote(10) |
Explanation of Responses: |
1. Represents the conversion of Class B Common Stock into Class A Common Stock held of record. |
2. These shares are held by KCS 2012 GRAT. |
3. Represents a transfer for no consideration to the Trust for Macy Shintaffer established under KCS 2012 GRAT and KDS 2012 GRAT (the "Macy Shintaffer Trust"), as to which Mr. Shintaffer and his spouse disclaim beneficial ownership. Neither Mr. Shintaffer nor his spouse is a beneficiary of the Macy Shintaffer Trust, nor does Mr. Shintaffer or his spouse exercise voting or investment control over such shares. The sole trustee of the Macy Shintaffer Trust, exercises voting and investment control over the shares held of record by the Macy Shintaffer Trust. |
4. These shares are held by KDS 2012 GRAT. |
5. Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a one-for-one basis and has no expiration date. |
6. Excludes 10,611 shares previously beneficially owned indirectly through the KCS 2012 GRAT which were distributed to the reporting person on March 12, 2018 and are now beneficially owned directly. |
7. Excludes 10,611 shares previously beneficially owned indirectly through the KDS 2012 GRAT which were distributed to the reporting person's spouse on March 12, 2018 and are now beneficially owned directly by the reporting person's spouse. |
8. Includes 10,611 shares previously beneficially owned indirectly through the KCS 2012 GRAT which were distributed to the reporting person on March 12, 2018 and are now beneficially owned directly. |
9. Includes 10,611 shares previously beneficially owned indirectly through the KDS 2012 GRAT which were distributed to the reporting person's spouse on March 12, 2018 and are now beneficially owned directly by the reporting person's spouse. |
10. These shares are held by the Reporting Person's spouse. |
Remarks: |
/s/ Frederick Williams, attorney-in-fact | 03/14/2018 | |
** 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. |