Sec Form 3 Filing - Olsen James T. @ CHP Merger Corp. - 2019-11-21

Insider filing report for Changes in Beneficial Ownership
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FORM 3
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Olsen James T.
2. Issuer Name and Ticker or Trading Symbol
CHP Merger Corp. [ CHPMU]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Executive Officer
(Last) (First) (Middle)
25 DEFOREST AVENUE, SUITE 108,
3. Date of Earliest Transaction (MM/DD/YY)
11/21/2019
(Street)
SUMMIT, NJ07901
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock ( 1 ) ( 1 ) ( 1 ) Class A Common Stock 7,906,250 ( 1 ) ( 2 ) I ( 3 ) See footnotes
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Olsen James T.
25 DEFOREST AVENUE, SUITE 108
SUMMIT, NJ07901
X Chief Executive Officer
CHP Acquisition Holdings LLC
C/O CHP ACQUISITION HOLDINGS LLC
25 DEFOREST AVENUE, SUITE 108
SUMMIT, NJ07901
X
Signatures
/s/ Benson Jose, as Attorney-in-Fact for James T. Olsen 11/21/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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.
( 2 )Includes up to 1,031,250 shares of Class B Common Stock subject to forfeiture depending on the extent to which the underwriters' over-allotment option is exercised as described in the Issuer's registration statement.
( 3 )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.

Remarks:
See Exhibit 24.1 - Power of Attorney

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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