Andy McCall - 17 Dec 2021 Form 4 Insider Report for Samsara Inc. (IOT)

Role
Executive Vice President, Chief Revenue Officer
Signature
/s/ Adam Eltoukhy, attorney-in-fact on behalf of Andy McCall
Issuer symbol
IOT
Transactions as of
17 Dec 2021
Transactions value $
$0
Form type
4
Filing time
21 Dec 2021, 20:51:17 UTC
Previous filing
14 Dec 2021
Next filing
17 Mar 2022
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
transaction IOT Series B Preferred Stock Conversion of derivative security $0 -1,323,000 -100% $0* 0 17 Dec 2021 Class B Common Stock 1,323,000 $0 Direct F1
transaction IOT Class B Common Stock Conversion of derivative security $0 +1,323,000 +4,804% $0 1,350,537 17 Dec 2021 Class A Common Stock 1,323,000 $0 Direct F1
holding IOT Class B Common Stock 5,020,001 17 Dec 2021 Class A Common Stock 5,020,001 $0 See footnote F2, F6
holding IOT Class B Common Stock 1,673,333 17 Dec 2021 Class A Common Stock 1,673,333 $0 See footnote F3, F6
holding IOT Class B Common Stock 836,666 17 Dec 2021 Class A Common Stock 836,666 $0 See footnote F4, F6
holding IOT Class B Common Stock 836,666 17 Dec 2021 Class A Common Stock 836,666 $0 See footnote F5, F6
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Each share of Series B Preferred Stock automatically converted into Class B Common Stock on a one-to-one basis immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock. 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.
F2 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.
F3 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.
F4 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.
F5 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.
F6 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.

Remarks:

Executive Vice President, Chief Revenue Officer