Ownership Submission
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FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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OMB APPROVAL
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OMB Number:3235-0104Expires:January 31, 2005Estimated average burden hours per response...0.5
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1. Name and Address of Reporting Person *
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NeoTribe Partners I, LLC
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2. Date of Event Requiring Statement (Month/Day/Year)
2021-12-30
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3. Issuer Name and Ticker or Trading Symbol
Heliogen, Inc. [HLGN]
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(Last)
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(First)
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(Middle)
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2744 SAND HILL RD. #150
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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_____ Director
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_____ 10% Owner
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_____ Officer (give title below)
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_____ Other (specify below)
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5. If Amendment, Date Original Filed(Month/Day/Year)
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(Street)
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MENLO PARK
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CA
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94025
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6. Individual or Join/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
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2. Amount of Securities Beneficially Owned
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3. Ownership Form: Direct (D) or Indirect (I)
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4. Nature of Indirect Beneficial Ownership
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
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2. Date Exercisable and Expiration Date
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3. Title and Amount of Securities Underlying Derivative Security
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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6. Nature of Indirect Beneficial Ownership
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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NeoTribe Partners I, LLC
2744 SAND HILL RD. #150
MENLO PARK, CA94025
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X
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NeoTribe Ventures I, L.P.
2744 SAND HILL RD. #150
MENLO PARK, CA94025
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X
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NeoTribe Associates I, L.P.
2744 SAND HILL RD. #150
MENLO PARK, CA94025
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X
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KOLLURI KRISHNA KITTU
2744 SAND HILL RD. #150
MENLO PARK, CA94025
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X
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Signatures
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NeoTribe Partners I, LLC, by: /s/ Krishna Kolluri, Managing Member
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2022-07-01
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**Signature of Reporting Person
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Date
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NeoTribe Ventures I, L.P., by: NeoTribe Partners I, LLC, its general partner, by: /s/ Krishna Kolluri, Managing Member
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2022-07-01
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**Signature of Reporting Person
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Date
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NeoTribe Associates I, L.P., by: NeoTribe Partners I, LLC, its general partner, by: /s/ Krishna Kolluri, Managing Member
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2022-07-01
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**Signature of Reporting Person
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Date
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/s/ Krishna Kolluri
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2022-07-01
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**Signature of Reporting Person
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Date
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Explanation of Responses:
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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(**)
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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(1)
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Shares are held directly by NeoTribe Ventures I, L.P. ("NTV I"). NeoTribe Partners I, LLC ("NTP I") is the general partner of NTV I. Krishna Kolluri ("Kolluri") is the managing member of NTP I and therefore may be deemed to hold voting and dispositive power over the shares held by NTV I. Such managing member disclaims beneficial ownership of the shares held by NTV I except to the extent of his pecuniary interest therein.
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(2)
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Shares are held directly by NeoTribe Associates I, L.P. ("NTA I"). NTP I is the general partner of NTA I. Kolluri is the managing member of NTP I and therefore may be deemed to hold voting and dispositive power over the shares held by NTA I. Such managing member disclaims beneficial ownership of the shares held by NTA I except to the extent of his pecuniary interest therein.
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