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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 |
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1. Name and Address of Reporting Person * SPURLOCK STEVEN M | 2. Issuer Name and Ticker or Trading Symbol Cyngn, Inc. [ CYN ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below) |
3. Date of Earliest Transaction
(MM/DD/YYYY)
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4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
1.Title of Security (Instr. 3) | 2. Trans. Date | 2A. Deemed Execution Date, if any |
3. Trans. Code (Instr. 8) |
4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 10/22/2021 | C | 8038585 | A | (1) | 8038585 | I | See footnotes (2) | ||
Common Stock | 10/22/2021 | C | 692418 | A | (1) | 8731003 | I | See footnotes (2) | ||
Common Stock | 10/22/2021 | C | 217622 | A | (1) | 8948625 | I | See footnotes (2) | ||
Common Stock | 10/22/2021 | C | 290162 | A | (1) | 290162 | I | See footnotes (3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Preferred Stock | (1) | 10/22/2021 | C | 8038585 | (1) | (1) | Common Stock | 8038585 | $0.00 | 0 | I | See footnotes (2) | |||
Series B Preferred Stock | (1) | 10/22/2021 | C | 692418 | (1) | (1) | Common Stock | 692418 | $0.00 | 0 | I | See footnotes (2) | |||
Series C Preferred Stock | (1) | 10/22/2021 | C | 217622 | (1) | (1) | Common Stock | 217622 | $0.00 | 0 | I | See footnotes (2) | |||
Series C Preferred Stock | (1) | 10/22/2021 | C | 290162 | (1) | (1) | Common Stock | 290162 | $0.00 | 0 | I | See footnotes (3) |
Remarks: This report is one of three reports, each on a separate Form 4, but relating to the same holdings being filed by entities affiliated with Benchmark and their applicable members. |
Reporting Owners | |||||
Reporting Owner Name / Address | |||||
Director | 10% Owner | Officer | Other | ||
SPURLOCK STEVEN M C/O BENCHMARK 2965 WOODSIDE ROAD WOODSIDE, CA 94062 | X | ||||
BALKANSKI ALEXANDRE C/O BENCHMARK 2965 WOODSIDE ROAD WOODSIDE, CA 94062 | X | ||||
DUNLEVIE BRUCE C/O BENCHMARK 2965 WOODSIDE ROAD WOODSIDE, CA 94062 | X | ||||
FENTON PETER H C/O BENCHMARK 2965 WOODSIDE ROAD WOODSIDE, CA 94062 | X | ||||
GURLEY J WILLIAM C/O BENCHMARK 2965 WOODSIDE ROAD WOODSIDE, CA 94062 | X | ||||
HARVEY KEVIN C/O BENCHMARK 2965 WOODSIDE ROAD WOODSIDE, CA 94062 | X | ||||
KAGLE ROBERT C/O BENCHMARK 2965 WOODSIDE ROAD WOODSIDE, CA 94062 | X | ||||
Cohler Matt C/O BENCHMARK 2965 WOODSIDE ROAD WOODSIDE, CA 94062 | X |
Signatures | ||
/s/ An-Yen Hu, by power of attorney for Steven M. Spurlock | 10/22/2021 | |
**Signature of Reporting Person | Date | |
/s/ An-Yen Hu, by power of attorney for Alexandre Balkanski | 10/22/2021 | |
**Signature of Reporting Person | Date | |
/s/ An-Yen Hu, by power of attorney for Bruce W. Dunlevie | 10/22/2021 | |
**Signature of Reporting Person | Date | |
/s/ An-Yen Hu, by power of attorney for Peter H. Fenton | 10/22/2021 | |
**Signature of Reporting Person | Date | |
/s/ An-Yen Hu, by power of attorney for J. William Gurley | 10/22/2021 | |
**Signature of Reporting Person | Date | |
/s/ An-Yen Hu, by power of attorney for Kevin R. Harvey | 10/22/2021 | |
**Signature of Reporting Person | Date | |
/s/ An-Yen Hu, by power of attorney for Robert C. Kagle | 10/22/2021 | |
**Signature of Reporting Person | Date | |
/s/ An-Yen Hu, by power of attorney for Matt Cohler | 10/22/2021 | |
**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 4(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. |