0001628280-22-025506.txt : 20220926
0001628280-22-025506.hdr.sgml : 20220926
20220926180125
ACCESSION NUMBER: 0001628280-22-025506
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 3
CONFORMED PERIOD OF REPORT: 20220922
FILED AS OF DATE: 20220926
DATE AS OF CHANGE: 20220926
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kouzoukas Demetrios L.
CENTRAL INDEX KEY: 0001856511
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39252
FILM NUMBER: 221266919
MAIL ADDRESS:
STREET 1: C/O CLOVER HEALTH INVESTMENTS, CORP.
STREET 2: 725 COOL SPRINGS BLVD., SUITE 320
CITY: FRANKLIN
STATE: FL
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_166422966400809.xml
FORM 4
X030642022-09-2200001801170CLOVER HEALTH INVESTMENTS, CORP. /DECLOV0001856511Kouzoukas Demetrios L.C/O CLOVER HEALTH INVESTMENTS, CORP.FRANKLINTN370671000Class A Common Stock2022-09-224M025608A25608DClass A Common Stock2022-09-224A0202710A45879DRestricted Stock Unit2022-09-224M000AClass A Common Stock25608.00DEach restricted stock unit ("RSU") represents a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement for no consideration.Represents shares of Class A common stock underlying a time-based RSU. One hundred percent of the RSUs will vest on the first anniversary of the Date of Grant, subject to the Reporting Person's continued service as a member of the Company's Board of Directors through such date.One hundred percent of the shares subject to the RSU award vested on the date of the 2022 Annual Meeting.Exhibit List 24.1-Power of Attorney EXHIBIT LIST: EX-24 Power of Attorney Demetrios L. Kouzoukas, GRAPHIC Power of Attorney Demetrios L. Kouzoukas/s/ Jamie L. Reynoso, Attorney-in-Fact for Demetrios L. Kouzoukas2022-09-26EX-24
2
kouzoukas_demetriosxlxpo.htm
POWER OF ATTORNEY DEMETRIOS L. KOUZOUKAS
kouzoukas_demetriosxlxpo
