SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
GROSS WILLIAM

(Last) (First) (Middle)
C/O IDEALAB
130 WEST UNION STREET

(Street)
PASADENA CA 91103

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/13/2023
3. Issuer Name and Ticker or Trading Symbol
Heliogen, Inc. [ HLGN ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 1,672,612 D
Common Stock 414,363 I See footnote(1)
Common Stock 16,175 I See footnote(2)
Common Stock 15,480,443 I See footnote(3)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) (4) 07/05/2023(5) Common Stock 2,738,864 $9 D
Employee Stock Option (right to buy) (6) 07/05/2023(5) Common Stock 2,621,465 $0.18 D
Employee Stock Option (right to buy) (7) 07/05/2023(5) Common Stock 4,209,710 $0.09 D
Explanation of Responses:
1. These shares are held by The Gross Goodstein Living Trust (the "Trust") of which Mr. Gross is a co-trustee. Mr. Gross may be deemed to beneficially own these shares. Mr. Gross disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
2. These shares are held by Idealab Studio, LLC ("Idealab Studio"), for which Mr. Gross serves as chairman and chief executive officer. The Trust owns a majority of the class of securities of Idealab Studio entitled to elect two managers to Idealab Studio's board of managers. Mr. Gross may be deemed to beneficially own these shares. Mr. Gross disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
3. These shares are held by Idealab Holdings, LLC ("Idealab Holdings"), which is a wholly owned subsidiary of Idealab, a California corporation ("Idealab"). Idealab is managed by a board of directors (the "Idealab Board") including Mr. Gross. On February 13, 2023, the Idealab Board revoked its delegation to one of the members of the Idealab Board, other than Mr. Gross, of Idealab's power to manage and control the business and affairs of Idealab Holdings related to these shares, including all voting and dispositive power with respect to these shares. Mr. Gross may be deemed to beneficially own these shares. Mr. Gross disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
4. The options vested and became exercisable in equal monthly installments commencing December 30, 2021, subject to Mr. Gross's continuous service which ceased effective February 5, 2023.
5. The options are exercisable through the indicated expiration date pursuant to an extension granted by the Issuer. The original expiration date was approximately 10 years from the initial vesting date of options with the same exercise price.
6. The options vested and became exercisable in equal monthly installments commencing December 21, 2020, subject to Mr. Gross's continuous service which ceased effective February 5, 2023.
7. The options vested and became exercisable in equal monthly installments commencing December 6, 2018, subject to Mr. Gross's continuous service which ceased effective February 5, 2023.
Remarks:
/s/ William Gross 04/14/2023
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: 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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