Statement of Changes in Beneficial Ownership (4)
June 17 2021 - 7:01PM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
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Kaveripatnam Sandesh |
2. Issuer Name and Ticker or Trading Symbol
Anaplan, Inc.
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PLAN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O ANAPLAN, INC., 50 HAWTHORNE STREET |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/15/2021 |
(Street)
SAN FRANCISCO, CA 94105
(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)
_X
_ Form filed by One Reporting Person
___ 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 | | | | | | | | 59283 | D | |
Common Stock | | | | | | | | 2413404 | I | By Napean Trading and Investment Company (Singapore) Pte. Ltd. (1) |
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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 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 |
Restricted Stock Units | (2) | 6/15/2021 | | A | | 3537 | | (2) | (2) | Common Stock | 3537 | $0.00 | 3537 | D | |
Explanation of Responses: |
(1) | Mr. Kaveripatnam is affiliated with Premji Invest. Napean Trading and Investment Co (Singapore) Pte. Ltd. is an entity affiliated with Premji Invest 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. |
(2) | The Reporting Person was granted restricted stock units ("RSUs") which represent a contingent right to receive one share of Common Stock for each RSU. The RSU shall vest in full on the earlier of: (i) the date of the next regular annual meeting of the Company's stockholders; and (ii) the one-year anniversary of the Date of Grant, provided that the Reporting Person remains in continuous service on such vesting date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Kaveripatnam Sandesh C/O ANAPLAN, INC. 50 HAWTHORNE STREET SAN FRANCISCO, CA 94105 | X |
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Signatures
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/s/ Gary Spiegel, Attorney-in-Fact | | 6/17/2021 |
**Signature of Reporting Person | Date |
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