0001213900-21-054215.txt : 20211022
0001213900-21-054215.hdr.sgml : 20211022
20211022163319
ACCESSION NUMBER: 0001213900-21-054215
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211022
FILED AS OF DATE: 20211022
DATE AS OF CHANGE: 20211022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Andreessen Marc L
CENTRAL INDEX KEY: 0001160077
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40932
FILM NUMBER: 211340937
MAIL ADDRESS:
STREET 1: C/O ARNOLD & PORTER LLP
STREET 2: 3 EMBARCADERO CENTER 7TH FLOOR
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94111
FORMER NAME:
FORMER CONFORMED NAME: ANDREESSEN MARC L
DATE OF NAME CHANGE: 20010925
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HOROWITZ BENJAMIN A
CENTRAL INDEX KEY: 0001166586
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40932
FILM NUMBER: 211340933
MAIL ADDRESS:
STREET 1: 2865 SAND HILL ROAD #101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Andreessen Horowitz Fund III-Q, L.P.
CENTRAL INDEX KEY: 0001540245
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40932
FILM NUMBER: 211340934
BUSINESS ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 798-3900
MAIL ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Andreessen Horowitz Fund III, L.P.
CENTRAL INDEX KEY: 0001540352
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40932
FILM NUMBER: 211340939
BUSINESS ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 798-3900
MAIL ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Andreessen Horowitz Fund III-B, L.P.
CENTRAL INDEX KEY: 0001540353
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40932
FILM NUMBER: 211340935
BUSINESS ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 798-3900
MAIL ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Andreessen Horowitz Fund III-A, L.P.
CENTRAL INDEX KEY: 0001540355
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40932
FILM NUMBER: 211340936
BUSINESS ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 798-3900
MAIL ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: AH Equity Partners III, L.L.C.
CENTRAL INDEX KEY: 0001540361
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40932
FILM NUMBER: 211340938
BUSINESS ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 798-3900
MAIL ADDRESS:
STREET 1: 2865 SAND HILL ROAD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Cyngn, Inc.
CENTRAL INDEX KEY: 0001874097
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING SERVICES [7371]
IRS NUMBER: 462007094
STATE OF INCORPORATION: DE
BUSINESS ADDRESS:
STREET 1: 1015 O'BRIEN DRIVE
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-924-5905
MAIL ADDRESS:
STREET 1: 1015 O'BRIEN DRIVE
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
ownership.xml
X0306
4
2021-10-22
0
0001874097
Cyngn, Inc.
CYN
0001540352
Andreessen Horowitz Fund III, L.P.
2865 SAND HILL ROAD, SUITE 101
MENLO PARK
CA
94025
0
0
1
0
0001540361
AH Equity Partners III, L.L.C.
2865 SAND HILL ROAD
SUITE 101
MENLO PARK
CA
94025
0
0
1
0
0001160077
Andreessen Marc L
2865 SAND HILL ROAD
SUITE 101
MENLO PARK
CA
94025
0
0
1
0
0001540355
Andreessen Horowitz Fund III-A, L.P.
2865 SAND HILL ROAD
SUITE 101
MENLO PARK
CA
94025
0
0
1
0
0001540353
Andreessen Horowitz Fund III-B, L.P.
2865 SAND HILL ROAD
SUITE 101
MENLO PARK
CA
94025
0
0
1
0
0001540245
Andreessen Horowitz Fund III-Q, L.P.
2865 SAND HILL ROAD
SUITE 101
MENLO PARK
CA
94025
0
0
1
0
0001166586
HOROWITZ BENJAMIN A
2865 SAND HILL ROAD
SUITE 101
MENLO PARK
CA
94025
0
0
1
0
Common Stock
2021-10-22
4
C
0
4947110
A
4947110
I
By Andreessen Horowitz Fund III, L.P.
Common Stock
2021-10-22
4
C
0
287718
A
287718
I
By Andreessen Horowitz Fund III, L.P.
Series B Preferred Stock
2021-10-22
4
C
0
4947110
0.00
D
Common Stock
4947110
0
I
By Andreessen Horowitz Fund III, L.P.
Series C Preferred Stock
2021-10-22
4
C
0
287718
0.00
D
Common Stock
287718
0
I
By Andreessen Horowitz Fund III, L.P.
These shares of Preferred Stock automatically converted into shares of the Issuer's Common Stock on a 1-for-1 basis, without payment or further consideration, immediately prior to the consummation of the Issuer's initial public offering.
These securities are held by Andreessen Horowitz Fund III, L.P., for itself and as nominee for Andreessen Horowitz Fund III-A, L.P., Andreessen Horowitz Fund III-B, L.P., and Andreessen Horowitz Fund III-Q, L.P. (collectively, the "AH Fund III Entities"). AH Equity Partners III, L.L.C. ("AH EP III") is the general partner of the AH Fund III Entities and has sole voting and dispositive power with regard to the securities held by the AH Fund III Entities. Marc Andreessen and Benjamin Horowitz are the managing members of AH EP III and share voting and dispositive power with respect to the shares held by the AH Fund III Entities. Each of the Reporting Persons disclaims the existence of a "group" and disclaims beneficial ownership of the securities held by the AH Fund III Entities and this report shall not be deemed an admission that any such person is the beneficial owner of such securities, except to the extent of such person's pecuniary interest therein, if any.
Scott Kupor has signed this Form 3 on behalf of Marc Andreessen and Benjamin Horowitz pursuant to a Power of Attorney already on file with the U.S. Securities and Exchange Commission.
Andreessen Horowitz Fund III, L.P., By: AH Equity Partners III, L.L.C., Its: General Partner, By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer
2021-10-22
AH Equity Partners III, L.L.C., By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer
2021-10-22
/s/ Scott Kupor, Attorney-in-Fact for Marc L. Andreessen
2021-10-22
Andreessen Horowitz Fund III-A, L.P., By: AH Equity Partners III, L.L.C., Its: General Partner, By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer
2021-10-22
Andreessen Horowitz Fund III-B, L.P., By: AH Equity Partners III, L.L.C., Its: General Partner, By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer
2021-10-22
Andreessen Horowitz Fund III-Q, L.P., By: AH Equity Partners III, L.L.C., Its: General Partner, By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer
2021-10-22
/s/ Scott Kupor, Attorney-in-Fact for Benjamin A. Horowitz
2021-10-22