0000899243-21-001387.txt : 20210111
0000899243-21-001387.hdr.sgml : 20210111
20210111182543
ACCESSION NUMBER: 0000899243-21-001387
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: Osborne Ian
CENTRAL INDEX KEY: 0001715393
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39252
FILM NUMBER: 21521904
MAIL ADDRESS:
STREET 1: YALDING HOUSE
STREET 2: 152 GREAT PORTLAND STREET
CITY: LONDON
STATE: X0
ZIP: W1W6AJ
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
0001715393
Osborne Ian
C/O 317 UNIVERSITY AVE, SUITE 200
PALO ALTO
CA
94301
0
0
1
1
FORMER PRESIDENT AND DIRECTOR
Class A Common Stock
2021-01-07
4
A
0
5000000
10.00
A
5000000
I
By Hedosophia Public Investments Limited
Class A Common Stock
2021-01-07
4
M
0
20500000
A
25500000
I
By SCH Sponsor III LLC
Class B ordinary share
2021-01-07
4
M
0
20500000
0.00
D
Class A Common Stock
20500000
0
I
By SCH Sponsor III LLC
On the basis of the reporting person's relationship with Hedosophia Public Investments Limited, the reporting person may be deemed a beneficial owner of the shares of the Issuer's Class A common stock, par value $0.0001 per share ("Class A Shares"), held by Hedosophia Public Investments Limited. The reporting person disclaims beneficial ownership of the Shares held by Hedosophia Public Investments Limited, except to the extent of his pecuniary interest therein.
On January 7, 2021, the Social Capital Hedosophia Holdings Corp. III ("SCH" and the former name of the Issuer) consummated its initial business combination (the "Business Combination") with Clover Health Investments, Corp. In connection with the consummation of the Business Combination, each share of Class B ordinary share, par value $0.0001 per share, of SCH automatically converted into one Class A Share.
A majority of the voting interests of SCH Sponsor III LLC ("Sponsor") are held by ChaChaCha SPAC C LLC ("ChaChaCha"). Messrs. Chamath Palihapitiya and Ian Osborne and ChaChaCha may be deemed to beneficially own the Class A Shares held by the Sponsor on the basis of their direct or indirect interests in the Sponsor or their shared control over the Sponsor, as the case may be. Each of Mr. Palihapitiya, Mr. Osborne and ChaChaCha disclaims beneficial ownership of the Class A Shares held by the Sponsor, except to the extent of such person's pecuniary interest therein.
/s/ Ian Osborne
2021-01-11