0001140361-19-021656.txt : 20191127 0001140361-19-021656.hdr.sgml : 20191127 20191127171856 ACCESSION NUMBER: 0001140361-19-021656 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191126 FILED AS OF DATE: 20191127 DATE AS OF CHANGE: 20191127 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Swedish Joseph CENTRAL INDEX KEY: 0001179745 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39140 FILM NUMBER: 191258973 MAIL ADDRESS: STREET 1: WELLPOINT, INC. STREET 2: 120 MONUMENT CIRCLE CITY: INDIANAPOLIS STATE: IN ZIP: 46204 FORMER NAME: FORMER CONFORMED NAME: SWEDISH JOSEPH DATE OF NAME CHANGE: 20020809 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CHP Acquisition Holdings LLC CENTRAL INDEX KEY: 0001785086 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39140 FILM NUMBER: 191258974 BUSINESS ADDRESS: STREET 1: C/O CHP ACQUISITION HOLDINGS LLC STREET 2: 25 DEFOREST AVENUE, SUITE 108 CITY: SUMMIT STATE: NJ ZIP: 07901 BUSINESS PHONE: 212-508-7090 MAIL ADDRESS: STREET 1: C/O CHP ACQUISITION HOLDINGS LLC STREET 2: 25 DEFOREST AVENUE, SUITE 108 CITY: SUMMIT STATE: NJ ZIP: 07901 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CHP Merger Corp. CENTRAL INDEX KEY: 0001785041 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 842590924 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: C/O CHP MERGER CORP. STREET 2: 25 DEFOREST AVENUE, SUITE 108 CITY: SUMMIT STATE: NJ ZIP: 07901 BUSINESS PHONE: 212-508-7090 MAIL ADDRESS: STREET 1: C/O CHP MERGER CORP. STREET 2: 25 DEFOREST AVENUE, SUITE 108 CITY: SUMMIT STATE: NJ ZIP: 07901 4 1 form4.xml FORM 4 X0306 4 2019-11-26 0001785041 CHP Merger Corp. CHPMU 0001179745 Swedish Joseph 25 DEFOREST AVENUE, SUITE 108 SUMMIT NJ 07901 true 0001785086 CHP Acquisition Holdings LLC 25 DEFOREST AVENUE, SUITE 108 SUMMIT NJ 07901 true Class B Common Stock 2019-11-26 4 J 0 406250 D Class A Common Stock 406250 7500000 I See footnote Shares of Class B Common Stock will automatically convert into shares of the Issuer's Class A Common Stock at the time of the Issuer's initial business combination on a one-for-one basis, subject to adjustment, as described under the heading "Description of Securities" in the Issuer's registration statement on form S-1 (File No. 333-234413) and have no expiration date. 406,250 shares of Class B Common Stock were forfeited to the Issuer at no cost in connection with the partial exercise by the underwriters of the over-allotment option, as described in the Issuer's registration statement on Form S-1. The securities are held directly by CHP Acquisition Holdings LLC, which is wholly owned by Concord Health Partners LLC. Each of Concord Health Partners LLC and the Reporting Person may be deemed to beneficially own the shares held by CHP Acquisition Holdings LLC by virtue of their direct and indirect ownership, respectively, of the shares of CHP Acquisition Holdings LLC. Each of Concord Health Partners LLC and the Reporting Person disclaims beneficial ownership over any securities owned by CHP Acquisition Holdings LLC other than to the extent of any pecuniary interest he or it may have therein, directly or indirectly. By: /s/ Benson Jose, Attorney-in-Fact Joseph R. Swedish 2019-11-27