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