0001213900-21-049655.txt : 20210923 0001213900-21-049655.hdr.sgml : 20210923 20210923212907 ACCESSION NUMBER: 0001213900-21-049655 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210917 FILED AS OF DATE: 20210923 DATE AS OF CHANGE: 20210923 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Innovation Endeavors III LP CENTRAL INDEX KEY: 0001720215 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39384 FILM NUMBER: 211273878 BUSINESS ADDRESS: STREET 1: 10 EAST 53RD STREET, 14TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 212-937-9095 MAIL ADDRESS: STREET 1: 10 EAST 53RD STREET, 14TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Berman Dror CENTRAL INDEX KEY: 0001883780 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39384 FILM NUMBER: 211273877 MAIL ADDRESS: STREET 1: C/O VICARIOUS SURGICAL INC. STREET 2: 78 4TH AVENUE CITY: WALTHAM STATE: MA ZIP: 02451 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 1 ownership.xml X0306 4 2021-09-17 0 0001812173 Vicarious Surgical Inc. RBOT 0001720215 Innovation Endeavors III LP C/O VICARIOUS SURGICAL INC. 78 FOURTH AVENUE WALTHAM MA 02451 0 0 1 0 0001883780 Berman Dror C/O VICARIOUS SURGICAL INC. 78 FOURTH AVENUE WALTHAM MA 02451 1 0 0 0 Class A Common Stock 2021-09-17 4 A 0 13436810 A 13436810 D In connection with the closing of the transactions contemplated by the Agreement and Plan of Merger, dated as of April 15, 2021, by and among D8 Holdings Corp. ("D8"), Snowball Merger Sub, Inc., a Delaware corporation and wholly owned subsidiary of D8 ("Merger Sub"), and Vicarious Surgical Inc., a Delaware corporation ("Vicarious"), pursuant to which Merger Sub merged with and into Vicarious, with Vicarious surviving as a wholly-owned subsidiary of D8 (which changed its name to "Vicarious Surgical Inc.", the "Issuer"), these shares were received in exchange for 3,313,025 Series A1 Preferred Stock, 456,520 Series A2 Preferred Stock and 304,302 Series A3 Preferred Stock of Vicarious. Dror Berman is a managing partner at Innovation Endeavors III LP and may be deemed to share voting and dispositive power over the shares held by Innovation Endeavors III LP. Such persons and entities disclaim beneficial ownership of shares held by Innovation Endeavors III LP, except to the extent of any pecuniary interest therein. /s/ June Morris, Attorney-in-Fact 2021-09-21