Statement of Changes in Beneficial Ownership (4)
April 12 2017 - 2:17PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Greylock XIII GP LLC
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2. Issuer Name
and
Ticker or Trading Symbol
Okta, Inc.
[
OKTA
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
2550 SAND HILL ROAD, SUITE 200
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3. Date of Earliest Transaction
(MM/DD/YYYY)
4/12/2017
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(Street)
MENLO PARK, CA 94025
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
_
X
_ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
(1)
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4/12/2017
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C
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12255309
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A
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$0.00
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12255309
(2)
(3)
(4)
(5)
(6)
(7)
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I
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By Greylock XIII Limited Partnership
(8)
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Common Stock
(1)
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4/12/2017
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C
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1103342
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A
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$0.00
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1103342
(2)
(3)
(4)
(5)
(6)
(7)
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I
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By Greylock XIII-A Limited Partnership
(9)
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Common Stock
(1)
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4/12/2017
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J
(1)
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12255309
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D
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$0.00
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0
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I
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By Greylock XIII Limited Partnership
(8)
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Common Stock
(1)
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4/12/2017
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J
(1)
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1103342
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D
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$0.00
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0
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I
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By Greylock XIII-A Limited Partnership
(9)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Series A Preferred Stock
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(2)
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4/12/2017
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C
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4929790
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(2)
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(2)
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Common Stock
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4929790
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$0.00
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0
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I
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By Greylock XIII Limited Partnership
(8)
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Series A Preferred Stock
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(2)
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4/12/2017
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C
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443829
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(2)
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(2)
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Common Stock
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443829
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$0.00
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0
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I
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By Greylock XIII-A Limited Partnership
(9)
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Series B Preferred Stock
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(3)
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4/12/2017
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C
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2877993
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(3)
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(3)
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Common Stock
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2877993
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$0.00
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0
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I
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By Greylock XIII Limited Partnership
(8)
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Series B Preferred Stock
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(3)
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4/12/2017
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C
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259105
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(3)
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(3)
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Common Stock
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259105
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$0.00
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0
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I
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By Greylock XIII-A Limited Partnership
(9)
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Series C Preferred Stock
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(4)
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4/12/2017
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C
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1245772
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(4)
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(4)
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Common Stock
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1245772
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$0.00
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0
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I
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By Greylock XIII Limited Partnership
(8)
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Series C Preferred Stock
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(4)
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4/12/2017
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C
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112156
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(4)
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(4)
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Common Stock
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112156
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$0.00
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0
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I
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By Greylock XIII-A Limited Partnership
(9)
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Series D Preferred Stock
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(5)
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4/12/2017
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C
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1158939
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(5)
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(5)
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Common Stock
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1158939
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$0.00
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0
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I
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By Greylock XIII Limited Partnership
(8)
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Series D Preferred Stock
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(5)
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4/12/2017
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C
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104338
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(5)
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(5)
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Common Stock
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104338
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$0.00
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0
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I
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By Greylock XIII-A Limited Partnership
(9)
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Series E Preferred Stock
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(6)
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4/12/2017
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C
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949734
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(6)
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(6)
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Common Stock
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949734
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$0.00
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0
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I
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By Greylock XIII Limited Partnership
(8)
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Series E Preferred Stock
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(6)
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4/12/2017
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C
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85504
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(6)
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(6)
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Common Stock
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85504
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$0.00
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0
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I
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By Greylock XIII-A Limited Partnership
(9)
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Series F Preferred Stock
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(7)
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4/12/2017
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C
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1093081
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(7)
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(7)
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Common Stock
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1093081
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$0.00
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0
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I
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By Greylock XIII Limited Partnership
(8)
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Series F Preferred Stock
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(7)
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4/12/2017
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C
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98410
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(7)
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(7)
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Common Stock
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98410
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$0.00
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0
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I
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By Greylock XIII-A Limited Partnership
(9)
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Class B Common Stock
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(10)
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4/12/2017
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J
(1)
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12255309
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(9)
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(9)
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Class A Common Stock
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12255309
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$0.00
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12255309
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I
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By Greylock XIII Limited Partnership
(8)
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Class B Common Stock
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(10)
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4/12/2017
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J
(1)
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1103342
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(9)
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(9)
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Class A Common Stock
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1103342
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$0.00
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1103342
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I
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By Greylock XIII-A Limited Partnership
(9)
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Explanation of Responses:
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(1)
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Immediately prior to the closing of the Issuer's initial public offering and following the conversion of each series of the Issuer's convertible preferred stock into Common Stock, each share of Common Stock was reclassified into one share of Class B Common Stock in an exempt transaction pursuant to Rule 16b-7.
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(2)
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The Series A Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
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(3)
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The Series B Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
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(4)
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The Series C Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
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(5)
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The Series D Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
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(6)
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The Series E Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
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(7)
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The Series F Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
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(8)
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The shares are held directly by Greylock XIII Limited Partnership ("Greylock XIII LP"). Greylock XIII GP Limited Liability Company ("Greylock XIII GP") is the sole General Partner of Greylock XIII LP and may be deemed to share voting and dispositive power with respect to the shares held by Greylock XIII LP. Greylock XIII GP disclaims beneficial ownership of the securities held by Greylock XIII LP except to the extent of any pecuniary interest therein and the inclusion of these securities in this report shall not be deemed an admission by Greylock XIII GP of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
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(9)
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The shares are held directly by Greylock XIII-A Limited Partnership ("Greylock XIII-A LP"). Greylock XIII GP Limited Liability Company ("Greylock XIII GP") is the sole General Partner of Greylock XIII-A LP and may be deemed to share voting and dispositive power with respect to the shares held by Greylock XIII-A LP. Greylock XIII GP disclaims beneficial ownership of the securities held by Greylock XIII LP except to the extent of any pecuniary interest therein and the inclusion of these securities in this report shall not be deemed an admission by Greylock XIII GP of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
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(10)
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Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder and has no expiration date.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Greylock XIII GP LLC
2550 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025
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X
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Greylock XIII Limited Partnership
2550 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025
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X
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Greylock XIII-A Limited Partnership
2550 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025
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X
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Signatures
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/s/ Donald A. Sullivan, as Administrative Partner of Greylock XIII GP LLC
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4/12/2017
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**
Signature of Reporting Person
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Date
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/s/ Donald A. Sullivan, as Administrative Partner of Greylock XIII GP LLC, the general partner of Greylock XIII Limited Partnership
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4/12/2017
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**
Signature of Reporting Person
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Date
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/s/ Donald A. Sullivan, as Administrative Partner of Greylock XIII GP LLC, the general partner of Greylock XIII-A Limited Partnership
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4/12/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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