Sec Form 4 Filing - Andreessen Horowitz Fund III, L.P. @ PagerDuty, Inc. - 2019-04-15

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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Andreessen Horowitz Fund III, L.P.
2. Issuer Name and Ticker or Trading Symbol
PagerDuty, Inc. [ PD]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
2865 SAND HILL ROAD, STE. 101
3. Date of Earliest Transaction (MM/DD/YY)
04/15/2019
(Street)
MENLO PARK, CA94025
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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 04/15/2019 C 11,832,375 A 11,832,375 I By Andreessen Horowitz Fund III, L.P. ( 2 ) ( 3 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 ) 04/15/2019 C 10,322,842 ( 1 ) ( 1 ) Common Stock 10,322,842 $ 0 0 I By Andreessen Horowitz Fund III, L.P. ( 2 ) ( 3 )
Series B Preferred Stock ( 1 ) 04/15/2019 C 1,494,120 ( 1 ) ( 1 ) Common Stock 1,494,120 $ 0 0 I By Andreessen Horowitz Fund III, L.P. ( 2 ) ( 3 )
Series C Preferred Stock ( 1 ) 04/15/2019 C 9,554 ( 1 ) ( 1 ) Common Stock 9,554 $ 0 0 I By Andreessen Horowitz Fund III, L.P. ( 2 ) ( 3 )
Series D Preferred Stock ( 1 ) 04/15/2019 C 5,859 ( 1 ) ( 1 ) Common Stock 5,859 $ 0 0 I By Andreessen Horowitz Fund III, L.P. ( 2 ) ( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Andreessen Horowitz Fund III, L.P.
2865 SAND HILL ROAD
STE. 101
MENLO PARK, CA94025
X
Andreessen Horowitz Fund III-A, L.P.
2865 SAND HILL ROAD
STE. 101
MENLO PARK, CA94025
X
Andreessen Horowitz Fund III-B, L.P.
2865 SAND HILL ROAD
STE. 101
MENLO PARK, CA94025
X
Andreessen Horowitz Fund III-Q, L.P.
2865 SAND HILL ROAD
STE. 101
MENLO PARK, CA94025
X
AH Equity Partners III, L.L.C.
2865 SAND HILL ROAD
STE. 101
MENLO PARK, CA94025
X
Andreessen Marc L
2865 SAND HILL ROAD
STE. 101
MENLO PARK, CA94025
X
HOROWITZ BENJAMIN A
2865 SAND HILL ROAD
STE. 101
MENLO PARK, CA94025
X
Signatures
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 04/15/2019
Signature of Reporting Person Date
AH Equity Partners III, LLC, By: /s/ Scott Kupor, Scott Kupor, Chief Operating Officer 04/15/2019
Signature of Reporting Person Date
Marc Andreessen, By: /s/ Scott Kupor, Scott Kupor, attorney-in-fact of Marc Andreessen 04/15/2019
Signature of Reporting Person Date
Ben Horowitz, By: /s/ Scott Kupor, Scott Kupor, attorney-in fact of Ben Horowitz 04/15/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The Preferred Stock converted into Common Stock on a one-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Preferred Stock was convertible at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Preferred Stock had no expiration date.
( 2 )The reported 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., or collectively, the AH Fund III Entities. The shares directly held by the AH Fund III Entities are indirectly held by AH Equity Partners III, L.L.C., or AH EP III, the general partner of the AH Fund III Entities, and by the managing members of AH EP III. 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.
( 3 )(Continued from Footnote 2) Such persons and entities disclaim beneficial ownership of the shares held by the AH Fund III Entities and this report shall not be deemed an admission that he or it is the beneficial owner of such shares, except to the extent of his or its pecuniary interest, if any, in such shares by virtue of his or its interest in the AH Fund III Entities, and/or the general partner entities thereof, as applicable.

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