0001693140-16-000001.txt : 20161223 0001693140-16-000001.hdr.sgml : 20161223 20161223123545 ACCESSION NUMBER: 0001693140-16-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20161223 DATE AS OF CHANGE: 20161223 EFFECTIVENESS DATE: 20161223 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Clover Intelligence, Inc. CENTRAL INDEX KEY: 0001693140 IRS NUMBER: 812710823 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-276980 FILM NUMBER: 162068492 BUSINESS ADDRESS: STREET 1: 112 S PARK STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94107 BUSINESS PHONE: (415) 895-2568 MAIL ADDRESS: STREET 1: 112 S PARK STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94107 D 1 primary_doc.xml X0707 D LIVE 0001693140 Clover Intelligence, Inc. 112 S PARK STREET SAN FRANCISCO CA CALIFORNIA 94107 (415) 895-2568 DELAWARE None None Corporation true 2016 Daria Evdokimova 112 S Park Street San Francisco CA CALIFORNIA 94107 Executive Officer Director Chief Executive Officer & Secretary Ethan Barhydt 112 S Park Street San Francisco CA CALIFORNIA 94107 Executive Officer Director President & Treasurer Other Technology Decline to Disclose 06b false 2016-12-12 false true false 0 2000000 1975000 25000 false 14 0 0 0 false Clover Intelligence, Inc. Daria Evdokimova Daria Evdokimova Chief Executive Officer & Secretary 2016-12-23