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