SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 03/10/2021 | 3. Issuer Name and Ticker or Trading Symbol Coupang, Inc. [ CPNG ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Class A Common Stock | 58,839,499 | I | By Disruptive Innovation Fund, L.P.(1) |
Class A Common Stock | 5,256,090 | I | By DIF Coupang, L.P.(1) |
Class A Common Stock | 9,363,600 | I | By DIF Coupang II, L.P.(1) |
Class A Common Stock | 3,663,480 | I | By DIF Coupang III, L.P.(1) |
Class A Common Stock | 2,922,924 | I | By DIF Coupang IV, L.P.(1) |
Class A Common Stock | 6,666,667 | I | By DIF Coupang V, LLC(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. Disruptive Innovation GP, LLC is the General Partner of Disruptive Innovation Fund, L.P., DIF Coupang, L.P., DIF Coupang II, L.P., and DIF Coupang III, L.P. DIF Coupang IV GP, LLC is the General Partner of DIF Coupang IV, L.P. Rose Park Advisors, LLC is the Manager of DIF Coupang V, LLC. Matthew Christensen is the Manager of Disruptive Innovation GP, LLC and Rose Park Advisors, LLC, and is the Managing Member of DIF Coupang IV GP, LLC, and may be deemed to have voting and dispositive power over the shares of the Company held by the previously listed entities. |
Remarks: |
/s/ Emily Epstein, Attorney-in-Fact | 03/10/2021 | |
** Signature of Reporting Person | Date | |
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 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |