0001628280-22-000730.txt : 20220111
0001628280-22-000730.hdr.sgml : 20220111
20220111215143
ACCESSION NUMBER: 0001628280-22-000730
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220107
FILED AS OF DATE: 20220111
DATE AS OF CHANGE: 20220111
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Garipalli Vivek
CENTRAL INDEX KEY: 0001839260
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39252
FILM NUMBER: 22525437
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: 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
wf-form4_164195588944291.xml
FORM 4
X0306
4
2022-01-07
0
0001801170
CLOVER HEALTH INVESTMENTS, CORP. /DE
CLOV
0001839260
Garipalli Vivek
C/O CLOVER HEALTH INVESTMENTS, CORP.
3401 MALLORY LANE, SUITE 210
FRANKLIN
TN
37067
1
1
1
0
Chief Executive Officer
Class B Common Stock
2022-01-07
4
M
0
3342698
A
3342698
D
Class B Common Stock
2022-01-07
4
F
0
1664825
3.16
D
1677873
D
Restricted Stock Unit
2022-01-07
4
M
0
3342698
0
D
Class B Common Stock
3342698.0
13370793
D
Each restricted stock unit ("RSU") represents a contingent right to receive one share of the Issuer's Class B Common Stock upon settlement for no consideration.
On January 7, 2021, the Reporting Person was granted 16,713,491 RSUs, vesting in equal annual installments over five years, beginning on January 7, 2022, subject to the continuous service of the Reporting Person as CEO, Co-CEO or Executive Chairman of the Issuer through each vesting date. Shares of the Issuer's Class B common stock will be delivered to the Reporting Person upon vesting.
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.
/s/ Gia Lee, as Attorney-in-Fact
2022-01-11