0000899243-21-032568.txt : 20210811 0000899243-21-032568.hdr.sgml : 20210811 20210811181830 ACCESSION NUMBER: 0000899243-21-032568 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210809 FILED AS OF DATE: 20210811 DATE AS OF CHANGE: 20210811 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Wagner Joseph F. CENTRAL INDEX KEY: 0001839810 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39252 FILM NUMBER: 211164934 MAIL ADDRESS: STREET 1: C/O CLOVER HEALTH INVESTMENTS, CORP. STREET 2: 725 COOL SPRINGS BLVD., SUITE 320 CITY: FRANKLIN STATE: TN ZIP: 37067 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 2021-08-09 0 0001801170 CLOVER HEALTH INVESTMENTS, CORP. /DE CLOV 0001839810 Wagner Joseph F. C/O CLOVER HEALTH INVESTMENTS, CORP. 725 COOL SPRINGS BLVD., SUITE 320 FRANKLIN TN 37067 0 1 0 0 Chief Financial Officer Class A Common Stock 2021-08-09 4 C 0 25000 A 25000 D Stock Options (right to buy) 2.23 2021-08-09 4 M 0 25000 0.00 D 2030-02-03 Class B Common Stock 25000 492018 D Class B Common Stock 2.23 2021-08-09 4 M 0 25000 0.00 A Class A Common Stock 25000 25000 D Class B Common Stock 2021-08-09 4 C 0 25000 0.00 D Class A Common Stock 25000 0 D The Class B Common Stock will be convertible into shares of Class A Common Stock on a one-to-one basis at the option of the holders of the Class B Common Stock at any time upon written notice to the Issuer. In addition, the Class B Common Stock will automatically convert into shares of Class A Common Stock immediately prior to the close of business on the earliest to occur of certain events specified in the Issuer's Amended and Restated Certificate of Incorporation. 100% of the stock option is immediately exercisable. The stock option vested as to 1/5th of the total number of shares on December 30, 2020 and continues to vest as to 1/60th of the total number of shares in equal monthly installments thereafter, subject to the continuous service of the Reporting Person on each vesting date. Joseph Wagner 2021-08-11