Andy McCall - 14 Dec 2021 Form 3 Insider Report for Samsara Inc. (IOT)

Role
Executive Vice President, Chief Revenue Officer Power of Attorney
Signature
/s/ Adam Eltoukhy, attorney-in-fact on behalf of Andy McCall
Issuer symbol
IOT
Transactions as of
14 Dec 2021
Transactions value $
$0
Form type
3
Filing time
14 Dec 2021, 20:18:24 UTC
Next filing
21 Dec 2021
SEC
View on sec.gov

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
holding IOT Stock Option (right to buy) 14 Dec 2021 Class B Common Stock 73,500 $0.05 Direct F1
holding IOT Stock Option (right to buy) 14 Dec 2021 Class B Common Stock 342,987 $3.51 Direct F2
holding IOT Series B Preferred Stock 14 Dec 2021 Class B Common Stock 1,323,000 Direct F3
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 27,537 Direct F4
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 5,020,001 See footnote F4, F5
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 1,673,333 See footnote F4, F6
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 836,666 See footnote F4, F7
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 836,666 See footnote F4, F8
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 The shares subject to the Option fully vested on November 1, 2018.
F2 1/48 of the total shares subject to the option vested on July 4, 2019 and thereafter 1/48 of the shares subject to the Option vest each month on the same day of the month.
F3 The Series B Preferred Stock is convertible into Class B Common Stock on a 1:1 basis and has no expiration date. Upon the closing of the Issuer's initial public offering, all shares of Series B Preferred Stock will be converted into shares of Class B Common Stock of the Issuer. The Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1:1 basis.
F4 The Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1:1 basis and has no expiration date.
F5 Consists of shares held by JAM and BAM, Co-Trustees of The JAM and BAM Joint Living Trust u/a/d 6/30/2009, over which Mr. McCall has voting or investment power.
F6 Consists of shares held by JAM and BAM, Co-Trustees of The McCall 2020 Irrevocable Children's Trust u/a/d 8/7/2020, over which Mr. McCall has voting or investment power.
F7 Consists of shares held by James Andrew McCall III, Trustee of The James Andrew McCall III 2020 Annuity Trust u/a/d 8/7/2020, over which Mr. McCall has voting or investment power.
F8 Consists of shares held by BAM, Trustee of The BAM 2020 Annuity Trust u/a/d 8/7/2020, over which Mr. McCall has voting or investment power.

Remarks:

Executive Vice President, Chief Revenue Officer Power of Attorney