0001209191-21-051683.txt : 20210816
0001209191-21-051683.hdr.sgml : 20210816
20210816183422
ACCESSION NUMBER: 0001209191-21-051683
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210816
FILED AS OF DATE: 20210816
DATE AS OF CHANGE: 20210816
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: 001-40561
FILM NUMBER: 211180358
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 IV LLC
CENTRAL INDEX KEY: 0001850376
STATE OF INCORPORATION: E9
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40561
FILM NUMBER: 211180359
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 IV, LLC
CENTRAL INDEX KEY: 0001869773
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40561
FILM NUMBER: 211180355
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: 001-40561
FILM NUMBER: 211180357
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: 001-40561
FILM NUMBER: 211180356
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. IV
CENTRAL INDEX KEY: 0001850272
STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770]
IRS NUMBER: 981586546
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
2021-08-16
0
0001850272
Social Capital Suvretta Holdings Corp. IV
DNAD
0001850376
SCS Sponsor IV LLC
SOCIAL CAPITAL SUVRETTA HLDNGS CORP IV
2850 W HORIZON RIDGE PARKWAY, STE 200
HENDERSON
NV
89052
1
0
1
0
0001715450
Palihapitiya Chamath
SOCIAL CAPITAL SUVRETTA HLDNGS CORP IV
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
0001869773
ChaChaCha DNA IV, LLC
SOCIAL CAPITAL SUVRETTA HLDNGS CORP IV
2850 W HORIZON RIDGE PARKWAY, STE 200
HENDERSON
NV
89052
1
0
1
0
Class B ordinary shares
2021-08-16
4
D
0
75000
0.00
D
Class A ordinary shares
75000
6220000
D
As described in the issuer's registration statement on Form S-1 (File No. 333-256727) under the heading "Description of Securities--Founder Shares," the Class B ordinary shares, par value $0.0001 per share, of the issuer will automatically convert into Class A ordinary shares, par value $0.0001 per share, of the issuer at the time of the issuer's initial business combination, or earlier at the option of the holder, on a one-for-one basis, subject to certain adjustment, and have no expiration date.
On August 16, 2021, SCS Sponsor IV LLC forfeited at no cost 75,000 shares of Class B common stock of the issuer in connection with the election by the underwriters of the issuer's initial public offering to decline to exercise in full their option to purchase additional Class A ordinary shares.
The reporting owner, SCS Sponsor IV 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 IV, 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.
SCS SPONSOR IV, LLC, By: /s/ James Ryans, as
Chief Financial Officer CHACHACHA DNA IV, LLC,
AARON COWEN, CHAMATH PALIHAPITIYA, and
KISHAN MEHTA, By: /s/ James Ryans, as attorney-infact
2021-08-16