0001209191-21-003166.txt : 20210111
0001209191-21-003166.hdr.sgml : 20210111
20210111211724
ACCESSION NUMBER: 0001209191-21-003166
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: Turner Nathaniel S.
CENTRAL INDEX KEY: 0001838734
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39252
FILM NUMBER: 21522232
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
2021-01-07
0
0001801170
CLOVER HEALTH INVESTMENTS, CORP. /DE
CLOV
0001838734
Turner Nathaniel S.
C/O CLOVER HEALTH INVESTMENTS, CORP.
725 COOL SPRINGS BLVD., SUITE 320
FRANKLIN
TN
37067
1
0
0
0
Class B Common Stock
2021-01-07
4
A
0
2565954
A
Class A Common Stock
2565954
2565954
I
Held by Multiple Holdings, LLC
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.
Received in connection with the Issuer's business combination (the "Business Combination") with Clover Health Investments, Corp. ("Legacy Clover") in accordance with the terms of the Agreement and Plan of Merger dated as of October 5, 2020, among the Issuer (f/k/a Social Capital Hedosophia Holdings Corp. III), Asclepius Merger Sub Inc., and Legacy Clover, as amended by that certain Amendment to the Agreement and Plan of Merger, dated as of December 8, 2020, in exchange for 1,330,273 shares of common stock of Legacy Clover.
The Reporting Person is a partner in Multiple Holdings, LLC and may be deemed to share voting power and dispositive power over the shares held by Multiple Holdings, LLC.
/s/ Gia Lee, as Attorney-in-Fact
2021-01-11