Andreessen Horowitz Fund III, L.P. - Oct 22, 2021 Form 4 Insider Report for Cyngn, Inc. (CYN)

Role
10%+ Owner
Signature
Andreessen Horowitz Fund III, L.P., By: AH Equity Partners III, L.L.C., Its: General Partner, By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer
Stock symbol
CYN
Transactions as of
Oct 22, 2021
Transactions value $
$0
Form type
4
Date filed
10/22/2021, 04:33 PM
Previous filing
Oct 19, 2021

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction CYN Common Stock Conversion of derivative security +4.95M 4.95M Oct 22, 2021 By Andreessen Horowitz Fund III, L.P. F1, F2
transaction CYN Common Stock Conversion of derivative security +288K 288K Oct 22, 2021 By Andreessen Horowitz Fund III, L.P. F1, F2

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
transaction CYN Series B Preferred Stock Conversion of derivative security $0 -4.95M -100% $0.00* 0 Oct 22, 2021 Common Stock 4.95M By Andreessen Horowitz Fund III, L.P. F1, F2
transaction CYN Series C Preferred Stock Conversion of derivative security $0 -288K -100% $0.00* 0 Oct 22, 2021 Common Stock 288K By Andreessen Horowitz Fund III, L.P. F1, F2
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 These shares of Preferred Stock automatically converted into shares of the Issuer's Common Stock on a 1-for-1 basis, without payment or further consideration, immediately prior to the consummation of the Issuer's initial public offering.
F2 These securities are held 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. (collectively, the "AH Fund III Entities"). AH Equity Partners III, L.L.C. ("AH EP III") is the general partner of the AH Fund III Entities and has sole voting and dispositive power with regard to the securities held by the AH Fund III Entities. Marc Andreessen and Benjamin Horowitz are the managing members of AH EP III and share voting and dispositive power with respect to the shares held by the AH Fund III Entities. Each of the Reporting Persons disclaims the existence of a "group" and disclaims beneficial ownership of the securities 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 securities, except to the extent of such person's pecuniary interest therein, if any.

Remarks:

Scott Kupor has signed this Form 3 on behalf of Marc Andreessen and Benjamin Horowitz pursuant to a Power of Attorney already on file with the U.S. Securities and Exchange Commission.