0000899243-21-040491.txt : 20211018
0000899243-21-040491.hdr.sgml : 20211018
20211018184935
ACCESSION NUMBER: 0000899243-21-040491
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210917
FILED AS OF DATE: 20211018
DATE AS OF CHANGE: 20211018
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KHOSLA VINOD
CENTRAL INDEX KEY: 0001032453
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39384
FILM NUMBER: 211329222
MAIL ADDRESS:
STREET 1: 2128 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: VK Services, LLC
CENTRAL INDEX KEY: 0001501927
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39384
FILM NUMBER: 211329223
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 376-8510
MAIL ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures Associates V, LLC
CENTRAL INDEX KEY: 0001611145
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39384
FILM NUMBER: 211329226
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-376-8500
MAIL ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures V, L.P.
CENTRAL INDEX KEY: 0001611146
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39384
FILM NUMBER: 211329227
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-376-8500
MAIL ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures Seed C, L.P.
CENTRAL INDEX KEY: 0001627897
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39384
FILM NUMBER: 211329225
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-376-8500
MAIL ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures Seed Associates C, LLC
CENTRAL INDEX KEY: 0001627898
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39384
FILM NUMBER: 211329224
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-376-8500
MAIL ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Vicarious Surgical Inc.
CENTRAL INDEX KEY: 0001812173
STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 78 FOURTH AVENUE
CITY: WALTHAM
STATE: MA
ZIP: 02451
BUSINESS PHONE: (617) 868-1700
MAIL ADDRESS:
STREET 1: 78 FOURTH AVENUE
CITY: WALTHAM
STATE: MA
ZIP: 02451
FORMER COMPANY:
FORMER CONFORMED NAME: D8 Holdings Corp.
DATE OF NAME CHANGE: 20200514
4/A
1
doc4a.xml
FORM 4/A SUBMISSION
X0306
4/A
2021-09-17
2021-09-21
0
0001812173
Vicarious Surgical Inc.
RBOT
0001611146
Khosla Ventures V, L.P.
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001611145
Khosla Ventures Associates V, LLC
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001627897
Khosla Ventures Seed C, L.P.
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001627898
Khosla Ventures Seed Associates C, LLC
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001501927
VK Services, LLC
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001032453
KHOSLA VINOD
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
CLASS A COMMON STOCK
2021-09-17
4
P
0
333334
10.00
A
13059335
I
See footnote
CLASS A COMMON STOCK
7896787
I
See footnote
Consists of securities held of record by Khosla Ventures V, L.P. ("KV V"), of which Khosla Ventures Associates V, LLC ("KVA V") is the general partner. Vinod Khosla is the managing member of VK Services, which is the sole manager of KVA V. Each of KVA V, VK Services and Vinod Khosla may be deemed to possess voting and investment control over such securities held by KV V, and each of KVA V, VK Services, and Vinod Khosla may be deemed to have indirect beneficial ownership of such securities held by KV V. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interests 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 purposes.
Consists of securities held of record by Khosla Ventures Seed C, L.P. ("KV Seed C"), of which Khosla Ventures Seed Associates C, LLC ("KVA Seed C") is the general partner. Vinod Khosla is the managing member of VK Services, LLC ("VK Services"), which is the sole manager of KVA Seed C. Each of KVA Seed C, VK Services and Vinod Khosla may be deemed to possess voting and investment control over such securities held by KV Seed C, and each of KVA Seed C, VK Services and Vinod Khosla may be deemed to have indirect beneficial ownership of such securities held by KV Seed C. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of his or its respective pecuniary interests 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 purposes.
This Form 4 amendment is being filed to include KV Seed C and KVA Seed C as reporting persons. This Form 4 amendment is intended to replace, in its entirety, the Form 4 filed on September 21, 2021.
/s/ John J. Demeter, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC, in its capacity as Manager of Khosla Ventures Associates V, LLC, in its capacity as general partner of Khosla Ventures V, L.P.
2021-10-18
/s/ John J. Demeter, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC, in its capacity as Manager of Khosla Ventures Associates V, LLC
2021-10-18
/s/ John J. Demeter, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC, in its capacity as Manager of Khosla Ventures Seed Associates C, LLC, in its capacity as general partner of Khosla Ventures Seed C, L.P.
2021-10-18
/s/ John J. Demeter, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC, in its capacity as Manager of Khosla Ventures Seed Associates C, LLC
2021-10-18
/s/ John J. Demeter, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC
2021-10-18
/s/ John J. Demeter, as attorney in fact for Vinod Khosla
2021-10-18