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