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