0000895345-23-000304.txt : 20230516 0000895345-23-000304.hdr.sgml : 20230516 20230516213911 ACCESSION NUMBER: 0000895345-23-000304 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230515 FILED AS OF DATE: 20230516 DATE AS OF CHANGE: 20230516 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: 23929510 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 form4.xml X0407 4 2023-05-15 0001801170 CLOVER HEALTH INVESTMENTS, CORP. /DE CLOV 0001856511 Kouzoukas Demetrios L. C/O CLOVER HEALTH INVESTMENTS, CORP. 3401 MALLORY LANE, SUITE FRANKLIN FL 37067 true false Class A Common Stock 2023-05-15 4 A 0 36585 0 A 259455 D Represents shares of Class A common stock of Clover Health Investments, Corp. (the "Company") underlying a time-based restricted stock unit award ("RSUs"). The RSUs will vest in full on the first anniversary of May 15, 2023, subject to the Reporting Person's continued service as a member of the Company's Board of Directors through such vesting date. Josheph R. Martin, Attorney-in-Fact 2023-05-16