0000902664-21-005107.txt : 20211124 0000902664-21-005107.hdr.sgml : 20211124 20211124180642 ACCESSION NUMBER: 0000902664-21-005107 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211122 FILED AS OF DATE: 20211124 DATE AS OF CHANGE: 20211124 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PERETZ BENJAMIN CENTRAL INDEX KEY: 0001840428 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39252 FILM NUMBER: 211448335 MAIL ADDRESS: STREET 1: 535 PACIFIC AVENUE STREET 2: 4TH FLOOR CITY: SAN FRANCISCO STATE: CA ZIP: 94133 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MEHTA NEIL CENTRAL INDEX KEY: 0001840890 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39252 FILM NUMBER: 211448336 MAIL ADDRESS: STREET 1: 535 PACIFIC AVENUE STREET 2: 4TH FLOOR CITY: SAN FRANCISCO STATE: CA ZIP: 94133 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GREENOAKS CAPITAL PARTNERS LLC CENTRAL INDEX KEY: 0001840735 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39252 FILM NUMBER: 211448337 BUSINESS ADDRESS: STREET 1: 535 PACIFIC AVENUE STREET 2: 4TH FLOOR CITY: SAN FRANCISCO STATE: CA ZIP: 94133 BUSINESS PHONE: 415-942-5322 MAIL ADDRESS: STREET 1: 535 PACIFIC AVENUE STREET 2: 4TH FLOOR CITY: SAN FRANCISCO STATE: CA ZIP: 94133 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: 3401 MALLORY LANE, SUITE 210 CITY: FRANKLIN STATE: TN ZIP: 37067 BUSINESS PHONE: (201) 432-2133 MAIL ADDRESS: STREET 1: 3401 MALLORY LANE, SUITE 210 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 ownership.xml X0306 4 2021-11-22 1 0001801170 CLOVER HEALTH INVESTMENTS, CORP. /DE CLOV 0001840735 GREENOAKS CAPITAL PARTNERS LLC 535 PACIFIC AVENUE 4TH FLOOR SAN FRANCISCO CA 94133 0 0 1 1 See Remarks 0001840890 MEHTA NEIL 535 PACIFIC AVENUE 4TH FLOOR SAN FRANCISCO CA 94133 0 0 1 0 0001840428 PERETZ BENJAMIN 535 PACIFIC AVENUE 4TH FLOOR SAN FRANCISCO CA 94133 0 0 1 0 Class B Common Stock 2021-11-22 4 J 0 24333120 D Class A Common Stock 24333120 25754556 I See footnote This transaction represents a pro-rata in-kind distribution by certain funds and accounts to which Greenoaks Capital Partners LLC ("Greenoaks Capital") serves as the investment adviser. All shares of Class B Common Stock will automatically convert into shares of Class A Common Stock upon the occurrence of certain events, including upon a transfer, other than certain permitted transfers, as set forth in the Issuer's certificate of incorporation, which is filed as Exhibit 3.1 to the Issuer's Current Report on Form 8-K filed by the Issuer with the Securities and Exchange Commission on January 12, 2021. Accordingly, such shares automatically converted in connection with the receipt of such distribution by the distributees. Subject to such automatic conversion provisions, the shares of Class B Common Stock have no expiration date. Each share of Class B Common Stock is convertible at any time at the option of the holder into one share of Class A Common Stock. The securities reported herein are held by certain funds and accounts to which Greenoaks Capital serves as the investment adviser and related persons or entities. Neil Mehta and Benjamin Peretz serve as Managing Directors of Greenoaks Capital. Each Reporting Person disclaims beneficial ownership in the securities reported herein except to the extent of its or his pecuniary interest, if any, therein, and this report shall not be deemed to be an admission that such Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. Greenoaks Capital Partners LLC, By: /s/ Neil Mehta, Managing Director 2021-11-24 /s/ Neil Mehta 2021-11-24 /s/ Benjamin Peretz 2021-11-24