Initial Statement of Beneficial Ownership (3)
01 Juli 2022 - 12:51AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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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Sloss Dakin |
2. Date of Event Requiring Statement (MM/DD/YYYY)
12/30/2021
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3. Issuer Name and Ticker or Trading Symbol
Heliogen, Inc. [HLGN]
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(Last)
(First)
(Middle)
P.O. BOX 12829 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
JACKSON, WY 83002
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
___ Form filed by One Reporting Person
_X_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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 | 19930277 | I | See footnote (1) |
Common Stock | 6668457 | I | See footnote (2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Explanation of Responses: |
(1) | Shares are held by Prime Movers Lab Fund I LP ("PML"). Prime Movers Lab GP I LLC ("PML GP") is the general partner of PML. Dakin Sloss is the manager of PML GP and may be deemed to have or share beneficial ownership of the shares held by PML. Mr. Sloss disclaims any beneficial ownership of the securities reported herein for purposes of Section 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), except to the extent of its pecuniary interest therein. |
(2) | Shares held by Heliogen PML SPV 1 LP ("Heliogen PML"). Prime Movers Lab GP II LLC ("PML GP II") is the general partner of Heliogen PML. Dakin Sloss is the manager of PML GP II and may be deemed to have or share beneficial ownership of the shares held by Heliogen PML. Mr. Sloss disclaims any beneficial ownership of the securities reported herein for purposes of Section 16 of the Exchange Act, except to the extent of its pecuniary interest therein. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Sloss Dakin P.O. BOX 12829 JACKSON, WY 83002 |
| X |
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Prime Movers Lab Fund I LP P.O. BOX 12829 JACKSON, WY 83002 |
| X |
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Heliogen PML SPV 1 LP P.O. BOX 12829 JACKSON, WY 83002 |
| X |
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Signatures
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/s/ Dakin Sloss /s/ Taylor Frankel, Authorized Person | | 6/30/2022 |
**Signature of Reporting Person | Date |
/s/ Prime Movers Lab Fund I LP /s/ Taylor Frankel, Authorized Person | | 6/30/2022 |
**Signature of Reporting Person | Date |
/s/ Heliogen PML SPV 1 LP /s/ Taylor Frankel, Authorized Person | | 6/30/2022 |
**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. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
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