0000899243-21-001382.txt : 20210111
0000899243-21-001382.hdr.sgml : 20210111
20210111181745
ACCESSION NUMBER: 0000899243-21-001382
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210107
FILED AS OF DATE: 20210111
DATE AS OF CHANGE: 20210111
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Reses Jacqueline D
CENTRAL INDEX KEY: 0001699681
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39252
FILM NUMBER: 21521884
MAIL ADDRESS:
STREET 1: C/O SQUARE, INC.
STREET 2: 1455 MARKET STREET #600
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CLOVER HEALTH INVESTMENTS, CORP. /DE
CENTRAL INDEX KEY: 0001801170
STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324]
IRS NUMBER: 981515192
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 725 COOL SPRINGS BLVD., SUITE 320
CITY: FRANKLIN
STATE: TN
ZIP: 37067
BUSINESS PHONE: (201) 432-2133
MAIL ADDRESS:
STREET 1: 725 COOL SPRINGS BLVD., SUITE 320
CITY: FRANKLIN
STATE: TN
ZIP: 37067
FORMER COMPANY:
FORMER CONFORMED NAME: CLOVER HEALTH INVESTMENTS, CORP.
DATE OF NAME CHANGE: 20210107
FORMER COMPANY:
FORMER CONFORMED NAME: Social Capital Hedosophia Holdings Corp. III
DATE OF NAME CHANGE: 20200124
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-01-07
1
0001801170
CLOVER HEALTH INVESTMENTS, CORP. /DE
CLOV
0001699681
Reses Jacqueline D
C/O 317 UNIVERSITY AVE, SUITE 200
PALO ALTO
CA
94301
0
0
0
1
FORMER DIRECTOR
Class A Common Stock
2021-01-07
4
M
0
100000
A
100000
D
Class A Common Stock
2021-01-07
4
A
0
200000
10.00
A
300000
D
Class B ordinary share
2021-01-07
4
M
0
100000
0.00
D
Class A Common Stock
100000
0
D
On January 7, 2021, the Social Capital Hedosophia Holdings Corp. III ("SCH" and the former name of the Issuer) consummated its initial business combination (the "Business Combination") with Clover Health Investments, Corp. In connection with the consummation of the Business Combination, each share of Class B ordinary share, par value $0.0001 per share, of SCH automatically converted into one share of the Issuer's Class A common stock, par value $0.0001 per share.
/s/ Jacqueline Reses
2021-01-11