SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 10/11/2018 | 3. Issuer Name and Ticker or Trading Symbol Anaplan, Inc. [ PLAN ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 10/11/2018 | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 4,000(1) | D(2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
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. On October 11, 2018, the Reporting Persons filed a Form 3 which inadvertently omitted 4,000 shares of Common Stock held directly by Christopher McKay, one of the Reporting Persons. These shares were also inadvertently omitted from the Form 4 filed by the Reporting Persons on October 18, 2018, after the original Form 3 was filed. |
2. The 4,000 shares of Common Stock are held directly by only one of the Reporting Persons, Christopher McKay. |
Remarks: |
GRANITE MANAGEMENT II, LLC, By Granite Ventures, LLC, Its Managing Member, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche, Title: Member | 02/20/2019 | |
GRANITE VENTURES, LLC, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche, Title: Member | 02/20/2019 | |
GRANITE VENTURES II, L.P., By Granite Management II, LLC, Its General Partner, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche, Title: Member | 02/20/2019 | |
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 | 02/20/2019 | |
GV ANAPLAN SPV, L.P., By Granite Ventures, LLC, Its General Partner, By /s/ Jacqueline Berterretche, Printed Name: Jacqueline Berterretche, Title: Member | 02/20/2019 | |
By: /s/ Jacqueline Berterretche, Jacqueline Berterretche | 02/20/2019 | |
By: /s/ Christopher McKay, Christopher McKay | 02/20/2019 | |
** 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 5 (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. |