0001209191-19-052895.txt : 20191009
0001209191-19-052895.hdr.sgml : 20191009
20191009210456
ACCESSION NUMBER: 0001209191-19-052895
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191008
FILED AS OF DATE: 20191009
DATE AS OF CHANGE: 20191009
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: OFARRELL JOHN
CENTRAL INDEX KEY: 0001191712
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38856
FILM NUMBER: 191145210
MAIL ADDRESS:
STREET 1: 2865 SAND HILL ROAD #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
2019-10-08
0
0001568100
PagerDuty, Inc.
PD
0001191712
OFARRELL JOHN
C/O ANDREESSEN HOROWITZ
2865 SAND HILL ROAD, STE. 101
MENLO PARK
CA
94025
1
0
0
0
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
2685
0.00
A
2685
I
By Trust
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 O'Farrell Principe Living Trust ua 4-30-1999 pursuant to pro rata distribution 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.
The shares are held of record by O'Farrell Principe Living Trust ua 4-30-1999 for which the Reporting Person is a trustee.
John L. O'Farrell, by /s/ Stacey A. Giamalis, Attorney-in- Fact
2019-10-09