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
Estimated average burden
hours per response... 0.5 |
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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 * 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] |
(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)
|
(Street)
JACKSON, WY 83002
(City)
(State)
(Zip)
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5. If Amendment, Date Original
Filed(MM/DD/YYYY)
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6. Individual or Joint/Group
Filing(Check Applicable Line)
___ Form filed by One Reporting Person
_X_ 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 |
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)
|
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
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Sloss Dakin
P.O. BOX 12829
JACKSON, WY 83002 |
|
X |
|
|
Prime Movers Lab Fund I LP
P.O. BOX 12829
JACKSON, WY 83002 |
|
X |
|
|
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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