SEC Form SC 13D/A filed by Clover Health Investments Corp. (Amendment)
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The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent
amendment containing information which would alter disclosures provided in a prior cover page.
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CUSIP No. 18914F111
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Page 2 of 9 pages |
1.
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Name of Reporting Person
SCH Sponsor III LLC
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2.
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Check the Appropriate Box if a Member of a Group
(a) ☐ (b) ⌧
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3.
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SEC Use Only
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4.
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Source of Funds
WC
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5.
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Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
☐
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6.
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Citizenship or Place of Organization
Cayman Islands
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Number of
Shares
Beneficially
Owned by
Each
Reporting
Person
With
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7.
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Sole Voting Power
0
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8.
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Shared Voting Power
0
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9.
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Sole Dispositive Power
0
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10.
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Shared Dispositive Power
0
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person
0
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares
☐
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13.
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Percent of Class Represented by Amount in Row (11)
0.0%
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14.
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Type of Reporting Person
OO
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CUSIP No. 18914F111
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Page 3 of 9 pages
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1.
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Name of Reporting Person
ChaChaCha SPAC C LLC
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2.
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Check the Appropriate Box if a Member of a Group
(a) ☐ (b) ⌧
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3.
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SEC Use Only
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4.
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Source of Funds
WC, BK
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5.
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Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
☐
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6.
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Citizenship or Place of Organization
Cayman Islands
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Number of
Shares
Beneficially
Owned by
Each
Reporting
Person
With
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7.
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Sole Voting Power
28,408,480
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8.
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Shared Voting Power
0
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9.
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Sole Dispositive Power
28,408,480
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10.
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Shared Dispositive Power
0
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person
28,408,480
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares
☐
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13.
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Percent of Class Represented by Amount in Row (11)
8.6%
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14.
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Type of Reporting Person
OO
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CUSIP No. 18914F111
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Page 4 of 9 pages
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1.
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Name of Reporting Person
Chamath Palihapitiya
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2.
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Check the Appropriate Box if a Member of a Group
(a) ☐ (b) ⌧
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3.
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SEC Use Only
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4.
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Source of Funds
WC, BK
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5.
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Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
☐
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6.
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Citizenship or Place of Organization
United States
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Number of
Shares
Beneficially
Owned by
Each
Reporting
Person
With
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7.
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Sole Voting Power
30,432,501
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8.
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Shared Voting Power
0
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9.
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Sole Dispositive Power
30,432,501
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10.
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Shared Dispositive Power
0
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person
30,432,501
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|||||||||||||
12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares
☐
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13.
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Percent of Class Represented by Amount in Row (11)
9.2%
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14.
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Type of Reporting Person
IN
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CUSIP No. 18914F111
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Page 5 of 9 pages
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1.
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Name of Reporting Person
Ian Osborne
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2.
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Check the Appropriate Box if a Member of a Group
(a) ☐ (b) ⌧
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3.
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SEC Use Only
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4.
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Source of Funds
WC
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5.
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Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
☐
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6.
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Citizenship or Place of Organization
United Kingdom
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Number of
Shares
Beneficially
Owned by
Each
Reporting
Person
With
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7.
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Sole Voting Power
4,063,919
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8.
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Shared Voting Power
0
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9.
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Sole Dispositive Power
4,063,919
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10.
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Shared Dispositive Power
0
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person
4,063,919
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares
☐
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13.
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Percent of Class Represented by Amount in Row (11)
1.2%
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14.
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Type of Reporting Person
IN
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Reporting Person(1)
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Amount
beneficially owned |
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Percent
of class |
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Sole
power to vote or to direct the vote |
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Shared
power to vote or to direct the vote |
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Sole power
to dispose or to direct the disposition |
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Shared
power to dispose or to direct the disposition |
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SCH Sponsor III LLC
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0
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0.0
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%
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0
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0
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0
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0
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ChaChaCha SPAC C LLC
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28,408,480
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8.6
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%
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28,408,480
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0
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28,408,480
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0
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Chamath Palihapitiya(1)
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30,432,501
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9.2
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%
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30,432,501
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0
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30,432,501
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0
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Ian Osborne
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4,063,919
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1.2
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%
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4,063,919
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0
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4,063,919
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0
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Exhibit
Number |
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Description
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6
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Joint Filing Agreement, dated as of January 14, 2022, by and among the Reporting Persons.
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Date: January 14, 2022
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SCH SPONSOR III LLC
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By:
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/s/ Chamath Palihapitiya
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Name:
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Chamath Palihapitiya
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Title:
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Chief Executive Officer
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ChaChaCha SPAC C LLC
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By:
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/s/ Chamath Palihapitiya
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Name:
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Chamath Palihapitiya
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Title:
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Manager
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Chamath Palihapitiya
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/s/ Chamath Palihapitiya
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Ian Osborne
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/s/ Ian Osborne
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