* | The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. |
1. | NAMES OF REPORTING PERSONS Ed Hallen | ||||||||||||||||
2. | CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a) ☐ (b) ☐ | ||||||||||||||||
3. | SEC USE ONLY | ||||||||||||||||
4. | CITIZENSHIP OR PLACE OF ORGANIZATION United States of America | ||||||||||||||||
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH: | 5. | SOLE VOTING POWER 32,989,106(1) | |||||||||||||||
6. | SHARED VOTING POWER 0 | ||||||||||||||||
7. | SOLE DISPOSITIVE POWER 32,989,106(1) | ||||||||||||||||
8. | SHARED DISPOSITIVE POWER 0 | ||||||||||||||||
9. | AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 32,989,106(1) | ||||||||||||||||
10. | CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES ☐ | ||||||||||||||||
11. | PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 44.7%(2) | ||||||||||||||||
12. | TYPE OF REPORTING PERSON IN |
(1) | Represents 32,989,106 shares of Series A Common Stock underlying shares of Series B common stock, par value $0.001 per share (the “Series B Common Stock”) held directly by the Reporting Person. | ||||
(2) | The percentage of class was calculated based on (i) 40,841,834 shares of Series A Common Stock outstanding as of December 31, 2023, as reported by the Issuer to the Reporting Person, plus (ii) 32,989,106 shares of Series A Common Stock issuable upon conversion of shares of Series B Common Stock beneficially owned by the Reporting Person, which are deemed outstanding pursuant to SEC Rule 13d-3(d)(1)(i) only for purposes of computing the percentage ownership of the Reporting Person. |
ITEM 1. | (a) Name of Issuer: | ||||
Klaviyo, Inc. (the “Issuer”). | |||||
(b) Address of Issuer’s Principal Executive Offices: | |||||
125 Summer Street, 6th Floor, Boston, MA 02110. | |||||
ITEM 2. | (a) Name of Person Filing: | ||||
Ed Hallen (the “Reporting Person”). | |||||
(b) Address or Principal Business Office: | |||||
The business address of the Reporting Person is c/o Klaviyo, Inc., 125 Summer Street, 6th Floor, Boston, MA 02110. | |||||
(c) Citizenship of each Reporting Person is: | |||||
The Reporting Person is a citizen of the United States of America. | |||||
(d) Title of Class of Securities: | |||||
Series A common stock, par value $0.001 per share (the “Series A Common Stock”). | |||||
(e) CUSIP Number: | |||||
49845K101 | |||||
ITEM 3. | |||||
Not applicable. | |||||
ITEM 4. Ownership. | |||||
The ownership information below represents beneficial ownership of Series A Common Stock of the Issuer as of December 31, 2023, based on (i) 40,841,834 shares of Series A Common Stock outstanding as of December 31, 2023, as reported by the Issuer to the Reporting Person, plus (ii) 32,989,106 shares of Series A Common Stock issuable upon conversion of shares of Series B Common Stock beneficially owned by the Reporting Person, which are deemed outstanding pursuant to SEC Rule 13d-3(d)(1)(i) only for purposes of computing the percentage ownership of the Reporting Person. | |||||
(a) Amount beneficially owned: | |||||
The Reporting Person may be deemed to be the beneficial owner of 32,989,106 shares of Series A Common Stock, consisting of 32,989,106 shares of Series A Common Stock underlying shares of Series B Common Stock held directly by the Reporting Person. | |||||
(b) Percent of class: | |||||
44.7% | |||||
(c) Number of shares as to which the person has: | |||||
(i) Sole power to vote or to direct the vote: 32,989,106 (ii) Shared power to vote or direct the vote: 0 (iii) Sole power to dispose or to direct the disposition of: 32,989,106 (iv) Shared power to dispose or to direct the disposition of: 0 | |||||
ITEM 5. Ownership of Five Percent or Less of a Class. | |||||
Not applicable. |
ITEM 6. Ownership of More than Five Percent on Behalf of Another Person. | ||||||||
Not applicable. | ||||||||
ITEM 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company. | ||||||||
Not applicable. | ||||||||
ITEM 8. Identification and Classification of Members of the Group. | ||||||||
Not applicable. | ||||||||
ITEM 9. Notice of Dissolution of Group. | ||||||||
Not applicable. | ||||||||
ITEM 10. Certification. | ||||||||
Not applicable. |
/s/ Ed Hallen | ||
ED HALLEN |