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