0001140361-19-021163.txt : 20191121 0001140361-19-021163.hdr.sgml : 20191121 20191121211643 ACCESSION NUMBER: 0001140361-19-021163 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20191121 FILED AS OF DATE: 20191121 DATE AS OF CHANGE: 20191121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Goulet Kenneth R CENTRAL INDEX KEY: 0001415516 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39140 FILM NUMBER: 191238580 MAIL ADDRESS: STREET 1: 120 MONUMENT CIRCLE CITY: INDIANAPOLIS STATE: IN ZIP: 46204 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 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 3 1 form3.xml FORM 3 X0206 3 2019-11-21 0 0001785041 CHP Merger Corp. CHPMU 0001415516 Goulet Kenneth R 25 DEFOREST AVENUE, SUITE 108 SUMMIT NJ 07901 true Class B Common Stock Class A Common Stock 25000 D 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. See Exhibit 24.1 - Power of Attorney /s/ Benson Jose, as Attorney-in-Fact for Kenneth Goulet 2019-11-21 EX-24.1 2 ex24_1.htm EXHIBIT 24.1
Exhibit 24.1

LIMITED POWER OF ATTORNEY

The undersigned hereby constitutes and appoints Benson Jose and Kevin Hueber, and each of them individually, with full power of substitution, as the undersigned’s true and lawful attorney-in-fact to:


 (1)
prepare, execute in the undersigned’s name and on the undersigned’s behalf, and submit to the U.S. Securities and Exchange Commission (the “SEC”) a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section 16(a) of the Securities Exchange Act of 1934, as amended, or any rule or regulation of the SEC;


(2)
execute for and on behalf of the undersigned, in the undersigned’s capacity as officer and/or director of CHP Merger Corp. (the “Company”), Forms 3, 4, 5 and any Schedules 13D or 13G in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended, and the rules thereunder;

 
(3)
do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to complete and execute any such Form 3, 4, or 5 or Schedule 13D or 13G, complete and execute any amendment or amendments thereto, and timely file such form with the SEC and any stock exchange or similar authority; and


(4)
take any other action of any type whatsoever in connection with the foregoing that, in the opinion of each such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by each such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as each such attorney-in-fact may approve in each such attorney-in-fact’s discretion.

The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that each such attorney-in-fact, or each such attorney-in-fact’s substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted.  The undersigned acknowledges that each foregoing attorney-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned’s responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended.

This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, 5, and any Schedules 13D or 13G with respect to the undersigned’s holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to each foregoing attorney-in-fact.


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IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 19th day of October, 2019.

 
/s/ Kenneth Goulet
  
 
Name: Kenneth Goulet
  

Signature Page to Limited Power of Attorney