Sec Form 4 Filing - MOHAN RAVI @ Anaplan, Inc. - 2019-05-28

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
MOHAN RAVI
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)
2440 SAND HILL ROAD, SUITE 300
3. Date of Earliest Transaction (MM/DD/YY)
05/28/2019
(Street)
MENLO PARK, CA94025
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 05/28/2019 J( 1 ) 3,400,000 D 10,027,098 I By Shasta Ventures II, L.P. ( 2 )
Common Stock 05/28/2019 J( 3 ) 707,200 A 707,200 I Shasta Ventures II GP, LLC ( 4 )
Common Stock 05/28/2019 J( 5 ) 690,200 D 17,000 I Shasta Ventures II GP, LLC ( 4 )
Common Stock 05/28/2019 J( 6 ) 149,257 A 149,257 D
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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
MOHAN RAVI
2440 SAND HILL ROAD, SUITE 300
MENLO PARK, CA94025
X
Signatures
/s/ Ravi Mohan 05/30/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Represents an in kind distribution without consideration by Shasta Ventures II, L.P. ("Shasta II") to its partners, including its general partner, Shasta Ventures II GP, LLC ("Shasta II GP").
( 2 )These shares are owned directly by Shasta II, of which Shasta II GP is the sole general partner and exercises voting and investment power over these shares. The reporting person is a managing director of Shasta II and disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
( 3 )Represents the receipt of shares in the pro rata in kind distribution of Common Stock of the Issuer by Shasta II described in footnote (1).
( 4 )These shares are owned directly by Shasta II GP. The reporting person is a managing director of Shasta II and disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
( 5 )Represents a pro-rata in-kind distribution of shares by Shasta II GP, without consideration, to its members.
( 6 )Represents a change in the form of ownership from indirect ownership to direct by virtue of the receipt of shares in the pro rata in kind distribution by Shasta II GP described in footnote (5).

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).

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