Statement of Changes in Beneficial Ownership (4)
03 Maio 2021 - 6:23PM
Edgar (US Regulatory)
FORM 4
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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 OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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REV Sponsor LLC |
2. Issuer Name and Ticker or Trading Symbol
Revolution Healthcare Acquisition Corp.
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REVH
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O REV. HEALTHCARE ACQUISITION CORP., 20 UNIVERSITY ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/1/2021 |
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(Street)
CAMBRIDGE, MA 02133
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Class B common stock (1) | 5/1/2021 | | D(2) | | 125000 | D | (2) | 2570625 | D (3) | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security
(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 |
| Explanation of Responses: |
| (1) | As described in the Issuer's registration statement on Form S-1 (File No. 333-253729), as amended, under the heading "Description of Securities - Alignment Shares," the shares of Class B common stock, par value $0.0001, will convert into shares of Class A common stock, par value $0.0001, pursuant to the performance of publicly traded shares of Class A common stock of the Issuer after the consummation of the Issuer's initial business combination. |
| (2) | The Class B common stock owned by the reporting person included up to 375,000 shares that were subject to forfeiture in the event the underwriters of the initial public offering of the Issuer's securities did not exercise in full their over-allotment option as described in the Issuer's registration statement. Because the underwriters exercised their over-allotment option in part, the reporting person forfeited 125,000 shares of Class B common stock on May 1, 2021 for no consideration. |
| (3) | This Form 4 is being filed by REV Sponsor LLC, the sponsor of the Issuer (the "Sponsor"). Sponsor is controlled by an affiliate of the Issuer. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
REV Sponsor LLC
C/O REV. HEALTHCARE ACQUISITION CORP.
20 UNIVERSITY ROAD
CAMBRIDGE, MA 02133 |
| X |
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Signatures
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| /s/ Evan Sotiriou, Attorney-in-Fact | | 5/3/2021 |
| **Signature of Reporting Person | Date |
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