Sec Form 4 Filing - Kaveripatnam Sandesh @ Anaplan, Inc. - 2018-10-16

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Kaveripatnam Sandesh
2. Issuer Name and Ticker or Trading Symbol
Anaplan, Inc. [ PLAN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O ANAPLAN, INC., 50 HAWTHORNE STREET
3. Date of Earliest Transaction (MM/DD/YY)
10/16/2018
(Street)
SAN FRANCISCO, CA94105
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 10/16/2018 C 35,806 ( 1 ) A 194,305 D
Common Stock 10/16/2018 P 29,411 ( 2 ) A $ 17 223,716 D
Common Stock 10/16/2018 C 6,461,625 ( 1 ) A 7,781,812 I By Napean Trading and Investment Company (Singapore) Pte. LTD ( 3 )
Common Stock 10/16/2018 P 1,075,588 ( 2 ) A $ 17 8,857,500 I By Napean Trading and Investment Company (Singapore) Pte. LTD ( 3 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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 A Convertible Preferred Stock ( 4 ) 10/16/2018 C 35,806 ( 4 ) ( 4 ) Common Stock 35,806 ( 4 ) 0 D
Series A Convertible Preferred Stock ( 4 ) 10/16/2018 C 327,168 ( 4 ) ( 4 ) Common Stock 327,168 ( 4 ) 0 I By Napean Trading and Investment Company (Singapore) Pte. LTD ( 3 )
Series E Convertible Preferred Stock ( 4 ) 10/16/2018 C 3,861,730 ( 4 ) ( 4 ) Common Stock 3,861,730 ( 4 ) 0 I By Napean Trading and Investment Company (Singapore) Pte. LTD ( 3 )
Series F Convertible Preferred Stock ( 4 ) 10/16/2018 C 2,272,727 ( 4 ) ( 4 ) Common Stock 2,272,727 ( 4 ) 0 I By Napean Trading and Investment Company (Singapore) Pte. LTD ( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Kaveripatnam Sandesh
C/O ANAPLAN, INC.
50 HAWTHORNE STREET
SAN FRANCISCO, CA94105
X
Signatures
/s/ Suhani Akhare, Attorney-in-Fact 10/18/2018
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The total represents shares received upon conversion of shares of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series E Convertible Preferred Stock and Series F Convertible Preferred Stock.
( 2 )Represents shares purchased in a private placement that closed concurrently with the Issuer's initial public offering.
( 3 )Napean Trading and Investment Co (Singapore) Pte. Ltd. is an entity affiliated with Premji Invest. Sandesh Kaveripatnam is a member of our board of directors and is a partner of Napean Trading and Investment Co (Singapore) Pte. Ltd and as such Mr. Kaveripatnam may be deemed to have voting and investment power with respect to such shares. Mr. Kaveripatnam disclaims beneficial ownership of the shares held by the aforementioned entity except to the extent of any pecuniary interest therein.
( 4 )The reported security converted into the Issuer's Common Stock on a 1-for-1 basis automatically immediately prior to the closing of the Issuer's initial public offering without payment of further consideration. The shares have no expiration date.

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