0001209191-21-045953.txt : 20210707 0001209191-21-045953.hdr.sgml : 20210707 20210707205212 ACCESSION NUMBER: 0001209191-21-045953 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210702 FILED AS OF DATE: 20210707 DATE AS OF CHANGE: 20210707 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Palihapitiya Chamath CENTRAL INDEX KEY: 0001715450 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40560 FILM NUMBER: 211078746 MAIL ADDRESS: STREET 1: C/O SOCIAL CAPITAL STREET 2: 317 UNIVERSITY AVE, SUITE 200 CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SCS Sponsor III LLC CENTRAL INDEX KEY: 0001850379 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40560 FILM NUMBER: 211078747 BUSINESS ADDRESS: STREET 1: 2850 W. HORIZON RIDGE PARKWAY STREET 2: SUITE 200 CITY: HENDERSON STATE: NV ZIP: 89052 BUSINESS PHONE: (650) 521-9007 MAIL ADDRESS: STREET 1: 2850 W. HORIZON RIDGE PARKWAY STREET 2: SUITE 200 CITY: HENDERSON STATE: NV ZIP: 89052 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ChaChaCha DNA III, LLC CENTRAL INDEX KEY: 0001869713 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40560 FILM NUMBER: 211078743 BUSINESS ADDRESS: STREET 1: 317 UNIVERSITY AVE, SUITE 200 CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: (650) 521-9007 MAIL ADDRESS: STREET 1: 317 UNIVERSITY AVE, SUITE 200 CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mehta Kishan CENTRAL INDEX KEY: 0001850520 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40560 FILM NUMBER: 211078745 MAIL ADDRESS: STREET 1: 540 WEST 49TH STREET STREET 2: UNIT# PH1N CITY: NEW YORK STATE: NY ZIP: 10019 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cowen Aaron CENTRAL INDEX KEY: 0001869640 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40560 FILM NUMBER: 211078744 MAIL ADDRESS: STREET 1: 540 MADISON AVENUE, 7TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Social Capital Suvretta Holdings Corp. III CENTRAL INDEX KEY: 0001850270 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 981586514 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2850 W. HORIZON RIDGE PARKWAY STREET 2: SUITE 200 CITY: HENDERSON STATE: NV ZIP: 89052 BUSINESS PHONE: (650) 521-9007 MAIL ADDRESS: STREET 1: 2850 W. HORIZON RIDGE PARKWAY STREET 2: SUITE 200 CITY: HENDERSON STATE: NV ZIP: 89052 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-07-02 0 0001850270 Social Capital Suvretta Holdings Corp. III DNAC 0001850379 SCS Sponsor III LLC SOCIAL CAPITAL SUVRETTA HLDNGS CORP III 2850 W HORIZON RIDGE PARKWAY, STE 200 HENDERSON NV 89052 1 0 1 0 0001715450 Palihapitiya Chamath SOCIAL CAPITAL SUVRETTA HLDNGS CORP III 2850 W HORIZON RIDGE PARKWAY, STE 200 HENDERSON NV 89052 1 1 1 0 Chief Executive Officer 0001850520 Mehta Kishan 540 MADISON AVENUE, 7TH FLOOR NEW YORK NY 10022 1 1 1 0 President 0001869640 Cowen Aaron 540 MADISON AVENUE, 7TH FLOOR NEW YORK NY 10022 0 0 1 0 0001869713 ChaChaCha DNA III, LLC SOCIAL CAPITAL SUVRETTA HLDNGS CORP III 2850 W HORIZON RIDGE PARKWAY, STE 200 HENDERSON NV 89052 1 0 1 0 Class A ordinary shares 2021-07-02 4 A 0 640000 10.00 A 640000 D The reporting owner, SCS Sponsor III LLC (the "Sponsor"), in whose name the securities reported herein are held, is managed by its managers, Chamath Palihapitiya and Kishan Mehta. A majority of the voting interests of the Sponsor are held by ChaChaCha DNA III, LLC ("ChaChaCha"), which is controlled by Mr. Palihapitiya. Messrs. Mehta and Cowen may be deemed to control the other member of the Sponsor. Messrs. Palihapitiya, Mehta and Cowen and ChaChaCha may be deemed to beneficially own shares held by the Sponsor by virtue of their direct or indirect interests in the Sponsor or their shared control over the Sponsor, as the case may be. Each of Mr. Palihapitiya, Mr. Mehta, ChaChaCha and Mr. Cowen disclaims beneficial ownership of the shares held by the Sponsor, except to the extent of such person's pecuniary interest therein. Exhibit 24.1 - Power of Attorney. On the basis of the relationship between the Sponsor, ChaChaCha and Messrs. Palihapitiya and Mehta, the Sponsor and ChaChaCha will be deemed directors by deputization. SCS SPONSOR III, LLC, By: /s/ James Ryans, as Chief Financial Officer CHACHACHA DNA III, LLC, AARON COWEN, CHAMATH PALIHAPITIYA, and KISHAN MEHTA, By: /s/ James Ryans, as attorney-in-fact 2021-07-07 EX-24.1 2 attachment1.htm EX-24.1 DOCUMENT

POWER OF ATTORNEY
For Executing Forms 3, 4 and 5

KNOW ALL BY THESE PRESENTS, that the undersigned hereby constitutes and appoints
each of Chamath Palihapitiya, Kishen Mehta, James Ryans and Shoney Katz, or any
of them, each acting alone, his or her true and lawful attorney-in-fact to:

(1) execute for and on behalf of the undersigned a Form 3, Form 4 or Form 5, or
any amendment thereto, relating to the securities of Social Capital Suvretta
Holdings Corp. III, in accordance with Section 16(a) of the Securities Exchange
Act of 1934 and the rules thereunder;

(2) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute such Form 3, Form 4 or
Form 5, or any amendment thereto, and the timely filing of such form with the
United States Securities and Exchange Commission and any other authority; and

(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of 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 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 such attorney-in-fact may approve in 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 and proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as such undersigned might
or could do if personally present, hereby ratifying and confirming all that such
attorney-in-fact 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 of the foregoing attorneys-in-fact, in serving in such
capacity at the request of the undersigned, is not assuming any of the
undersigned's responsibilities to comply with Section 16 of the Securities
Exchange Act of 1934. This Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to file Forms 3, 4 and 5 with
respect to the undersigned's holdings of and transactions in securities issued
by Social Capital Suvretta Holdings Corp. III unless earlier revoked by the
undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 7th day of July, 2021.

CHACHACHA DNA III, LLC

By: /s/ Chamath Palihapitiya
Name: Chamath Palihapitiya