0000899243-21-010331.txt : 20210308 0000899243-21-010331.hdr.sgml : 20210308 20210308160522 ACCESSION NUMBER: 0000899243-21-010331 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210308 FILED AS OF DATE: 20210308 DATE AS OF CHANGE: 20210308 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kaul Samir CENTRAL INDEX KEY: 0001501915 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40131 FILM NUMBER: 21721945 MAIL ADDRESS: STREET 1: C/O KHOSLA VENTURES STREET 2: 3000 SAND HILL ROAD, BLDG. 3, SUITE 170 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Khosla Ventures SPAC Sponsor LLC CENTRAL INDEX KEY: 0001846071 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40131 FILM NUMBER: 21721944 BUSINESS ADDRESS: STREET 1: 2128 SAND HILL RD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 6503768500 MAIL ADDRESS: STREET 1: 2128 SAND HILL RD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SK SPAC Services, LLC CENTRAL INDEX KEY: 0001848897 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40131 FILM NUMBER: 21721942 BUSINESS ADDRESS: STREET 1: 2128 SAND HILL RD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 6503768500 MAIL ADDRESS: STREET 1: 2128 SAND HILL RD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Khosla Ventures SPAC Sponsor Services LLC CENTRAL INDEX KEY: 0001848793 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40131 FILM NUMBER: 21721943 BUSINESS ADDRESS: STREET 1: 2128 SAND HILL RD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 6503768500 MAIL ADDRESS: STREET 1: 2128 SAND HILL RD CITY: MENLO PARK STATE: CA ZIP: 94025 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Khosla Ventures Acquisition Co. CENTRAL INDEX KEY: 0001841873 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-03-08 0 0001841873 Khosla Ventures Acquisition Co. KVSA 0001501915 Kaul Samir C/O KHOSLA VENTURES ACQUISITION CO. 2128 SAND HILL RD MENLO PARK CA 94025 1 1 1 0 Chief Executive Officer 0001846071 Khosla Ventures SPAC Sponsor LLC C/O KHOSLA VENTURES ACQUISITION CO. 2128 SAND HILL RD MENLO PARK CA 94025 0 0 1 0 0001848793 Khosla Ventures SPAC Sponsor Services LLC C/O KHOSLA VENTURES ACQUISITION CO. 2128 SAND HILL RD MENLO PARK CA 94025 0 0 1 0 0001848897 SK SPAC Services, LLC C/O KHOSLA VENTURES ACQUISITION CO. 2128 SAND HILL RD MENLO PARK CA 94025 0 0 1 0 Class A Common Stock 2021-03-08 4 A 0 990000 10.00 A 990000 I See footnote Khosla Ventures SPAC Sponsor LLC ("Sponsor") is the record holder of the shares reported herein. Khosla Ventures SPAC Sponsor Services LLC is the owner of Sponsor. VK Services LLC and SK SPAC Services, LLC are the joint owners of Khosla Ventures SPAC Sponsor Services LLC. Vinod Khosla and Samir Kaul are the managing members of VK Services LLC and SK SPAC Services, LLC, respectively. As such, each of VK Services LLC, SK SPAC Services, LLC and Messrs. Khosla and Kaul may be deemed to share beneficial ownership of the shares held directly by Sponsor. Each of VK Services LLC, SK SPAC Services, LLC and Messrs. Khosla and Kaul disclaim any beneficial ownership of such shares other than to the extent of their pecuniary interest therein. /s/ Samir Kaul, on behalf of himself and each of Khosla Ventures SPAC Sponsor LLC, Khosla Ventures SPAC Sponsor Services LLC and SK SPAC Services, LLC 2021-03-08