Sec Form 4 Filing - Garipalli Vivek @ CLOVER HEALTH INVESTMENTS, CORP. /DE - 2021-01-07

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Garipalli Vivek
2. Issuer Name and Ticker or Trading Symbol
CLOVER HEALTH INVESTMENTS, CORP. /DE [ CLOV]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Executive Officer
(Last) (First) (Middle)
C/O CLOVER HEALTH INVESTMENTS, CORP., 725 COOL SPRINGS BLVD., SUITE 320
3. Date of Earliest Transaction (MM/DD/YY)
01/07/2021
(Street)
FRANKLIN, TN37067
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock ( 1 ) 01/07/2021 A 75,694,143 ( 1 ) ( 1 ) Class A Common Stock 75,694,143 ( 2 ) 75,694,143 I Held by NJ Healthcare Investments, LLC ( 3 )
Class B Common Stock ( 1 ) 01/07/2021 A 182,201 ( 1 ) ( 1 ) Class A Common Stock 182,201 ( 4 ) 182,201 I Held by Titus Ventures, LLC ( 3 )
Class B Common Stock ( 1 ) 01/07/2021 A 5,645,934 ( 1 ) ( 1 ) Class A Common Stock 5,645,934 ( 5 ) 5,645,934 I Held by Caesar Ventures, LLC ( 3 )
Class B Common Stock ( 1 ) 01/07/2021 A 2,062,265 ( 1 ) ( 1 ) Class A Common Stock 2,062,265 ( 6 ) 2,062,265 I Held by Caesar Clover, LLC ( 3 )
Performance-based Restricted Stock Units ( 7 ) 01/07/2021 A 7,164,581 ( 7 ) ( 7 ) Class B Common Stock ( 1 ) 7,164,581 ( 8 ) 7,164,581 D
Restricted Stock Units ( 9 ) 01/07/2021 A 16,713,491 ( 10 ) ( 10 ) Class B Common Stock ( 1 ) 16,713,491 $ 0 16,713,491 D
Performance-based Restricted Stock Units ( 7 ) 01/07/2021 A 5,571,164 ( 7 ) ( 7 ) Class B Common Stock ( 1 ) 5,571,164 $ 0 5,571,164 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Garipalli Vivek
C/O CLOVER HEALTH INVESTMENTS, CORP.
725 COOL SPRINGS BLVD., SUITE 320
FRANKLIN, TN37067
X X Chief Executive Officer
Signatures
/s/ Gia Lee, as Attorney-in-Fact 01/11/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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. In addition, the Class B Common Stock will automatically convert into shares of Class A Common Stock immediately prior to the close of business on the earliest to occur of certain events specified in the Issuer's Amended and Restated Certificate of Incorporation.
( 2 )Received in connection with the Issuer's business combination (the "Business Combination") with Clover Health Investments, Corp. ("Legacy Clover") in accordance with the terms of the Agreement and Plan of Merger dated as of October 5, 2020, among the Issuer (f/k/a Social Capital Hedosophia Holdings Corp. III), Asclepius Merger Sub Inc., and Legacy Clover, as amended by that certain Amendment to the Agreement and Plan of Merger, dated as of December 8, 2020, in exchange for 36,601,265 shares of Class Z common stock of Legacy Clover.
( 3 )The Reporting Person serves as the sole manager of each of NJ Healthcare Investments, LLC, Titus Ventures, LLC, Caesar Ventures, LLC and Caesar Clover, LLC. Therefore, the Reporting Person may be deemed to share voting power and dispositive power over the shares held by these entities.
( 4 )Received in connection with the Business Combination in exchange for 88,102 shares of Class Z common stock of Legacy Clover.
( 5 )Received in connection with the Business Combination in exchange for 2,730,044 shares of Class Z common stock of Legacy Clover.
( 6 )Received in connection with the Business Combination in exchange for 997,191 shares of Class Z common stock of Legacy Clover.
( 7 )Each performance-based restricted stock unit ("PRSU") represents a contingent right to receive one share of the Issuer's Class B Common Stock. The PRSUs generally vest in five equal installments on January 7 of each of 2022, 2023, 2024, 2025 and 2026 respectively, provided that the applicable performance goal has been achieved by such date (and, if not, on the date the applicable performance goal is subsequently achieved), and are subject to the continuous service of the Reporting Person as CEO, Co-CEO or Executive Chairman of the Issuer through the applicable vesting date. The applicable performance goal for each tranche will be satisfied if the Issuer's Class A Common Stock achieves a specified per share market price for such tranche for at least 90 consecutive calendar days. If the applicable performance goals have not been achieved by January 7, 2026, all unvested PRSUs will be forfeited.
( 8 )Received in connection with the Business Combination in exchange for restricted stock units that will have settled for 3,464,373 shares of common stock of Legacy Clover.
( 9 )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.
( 10 )The RSUs will vest 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.

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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