0001209191-19-052894.txt : 20191009
0001209191-19-052894.hdr.sgml : 20191009
20191009210021
ACCESSION NUMBER: 0001209191-19-052894
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191007
FILED AS OF DATE: 20191009
DATE AS OF CHANGE: 20191009
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: 001-38856
FILM NUMBER: 191145200
MAIL ADDRESS:
STREET 1: 2865 SAND HILL ROAD #101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
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: 001-38856
FILM NUMBER: 191145201
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: 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: 001-38856
FILM NUMBER: 191145202
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-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: 001-38856
FILM NUMBER: 191145203
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: 001-38856
FILM NUMBER: 191145204
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: 001-38856
FILM NUMBER: 191145205
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: 001-38856
FILM NUMBER: 191145206
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: PagerDuty, Inc.
CENTRAL INDEX KEY: 0001568100
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 272793871
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0131
BUSINESS ADDRESS:
STREET 1: 600 TOWNSEND STREET #200
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
BUSINESS PHONE: (844) 800-3889
MAIL ADDRESS:
STREET 1: 600 TOWNSEND STREET #200
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2019-10-07
0
0001568100
PagerDuty, Inc.
PD
0001540352
Andreessen Horowitz Fund III, L.P.
2865 SAND HILL ROAD, STE. 101
MENLO PARK
CA
94025
0
0
1
0
0001540355
Andreessen Horowitz Fund III-A, L.P.
2865 SAND HILL ROAD
STE. 101
MENLO PARK
CA
94025
0
0
1
0
0001540353
Andreessen Horowitz Fund III-B, L.P.
2865 SAND HILL ROAD
STE. 101
MENLO PARK
CA
94025
0
0
1
0
0001540245
Andreessen Horowitz Fund III-Q, L.P.
2865 SAND HILL ROAD
STE. 101
MENLO PARK
CA
94025
0
0
1
0
0001540361
AH Equity Partners III, L.L.C.
2865 SAND HILL ROAD
STE. 101
MENLO PARK
CA
94025
0
0
1
0
0001160077
Andreessen Marc L
2865 SAND HILL ROAD
STE. 101
MENLO PARK
CA
94025
0
0
1
0
0001166586
HOROWITZ BENJAMIN A
2865 SAND HILL ROAD
STE. 101
MENLO PARK
CA
94025
0
0
1
0
Common Stock
2019-10-07
4
J
0
8524
0.00
A
8524
I
By: LAMA Community Trust
Common Stock
2019-10-08
4
J
0
1774856
0.00
D
10057519
I
By Andreessen Horowitz Fund III, L.P.
Common Stock
2019-10-08
4
J
0
17555
0.00
D
0
I
By: AH Equity Partners III, L.L.C.
Common Stock
2019-10-08
4
J
0
5860
0.00
A
5860
I
By: 1997 Horowitz Family Trust
Common Stock
2019-10-08
4
J
0
12587
0.00
A
21111
I
By: LAMA Community Trust
Common Stock
2019-10-08
4
J
0
359
0.00
A
359
I
By: AH Capital Management, L.L.C.
Represents shares received by the LAMA Community Trust pursuant to a pro rata distribution by SV Angel II, L.P., for no consideration, of shares of Common Stock of the Issuer to its partners.
The shares are held of record by the LAMA Community Trust of which Marc Andreessen and his spouse are trustees. Each of the Reporting Persons disclaims the existence of a "group" and, other than Marc Andreessen, disclaims beneficial ownership of these securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purpose.
On October 8, 2019, 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") distributed, for no consideration, 1,774,856 shares of Common Stock of the Issuer (the "Fund III Shares") to their respective limited partners and to AH Equity Partners III, L.L.C.("AH EP III"), the general partner of the AH Fund III Entities, representing each such partner's pro rata interest in such Fund III Shares.
The reported securities are held of record 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. AH EP III is the general partner of the AH Fund III Entities. The managing members of AH EP III are Marc Andreessen and Ben Horowitz. AH EP III and its managing members share voting and dispositive power with regard to the securities held by the AH Fund III Entities.
Each of the Reporting Persons disclaims the existence of a "group" and disclaims beneficial ownership of the shares 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 shares), except to the extent of its pecuniary interest, if any, in such shares by virtue of its interest in the AH Fund III Entities and/or AH EP III, as applicable.
On October 8, 2019, AH EP III distributed, for no consideration, 17,555 shares of the Fund III Shares to its members, representing each such member's pro rata interest in such Fund III Shares.
The managing members of AH EP III are Marc Andreessen and Ben Horowitz. AH EP III and its managing members share voting and dispositive power with regard to the securities held by the AH Fund III Entities. Each of the Reporting Persons disclaims the existence of a "group" and disclaims beneficial ownership of these securities, except to the extent of its pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purpose.
Represents shares received by Ben Horowitz pursuant to pro rata distributions by the AH Fund III Entities and AH EP III, for no consideration, of shares of Fund III Shares to their respective partners and such partners' members, as applicable.
The shares are held of record by a family trust for which Ben Horowitz is a trustee. Each of the Reporting Persons disclaims the existence of a "group" and, other than Ben Horowitz, disclaims beneficial ownership of these securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purpose.
Represents shares received by the LAMA Community Trust pursuant to pro rata distributions by the AH Fund III Entities and AH EP III, for no consideration, of shares of the Fund III Shares to their respective partners and such partner's members, as applicable.
Represents shares received by AH Capital Management, L.L.C. pursuant to pro rata distributions by the AH Fund III Entities and AH EP III, for no consideration, of shares of the Fund III Shares to their respective partners and such partners' members, as applicable.
The shares are held of record by AH Capital Management, L.L.C. The members of AH Capital Management, L.L.C. are Marc Andreessen and Ben Horowitz, who share voting and investment power with respect to the shares held by AH Capital Management, L.L.C. Each of the Reporting Persons disclaims the existence of a "group" and disclaims beneficial ownership of these securities except to the extent of its pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purpose.
Andreessen Horowitz Fund III, LP, Andreessen Horowitz Fund III-A, LP, Andreessen Horowitz Fund III-B, LP, Andreessen Horowitz Fund III-Q, LP, By: AH Equity Partners III, LLC, Its general partner, By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer
2019-10-09
AH Equity Partners III, LLC, By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer
2019-10-09
Marc Andreessen, By: /s/ Scott Kupor, Scott Kupor, attorney-in-fact of Marc Andreessen
2019-10-09
Ben Horowitz, By: /s/ Scott Kupor, Scott Kupor, attorney-in fact of Ben Horowitz
2019-10-09