0001783087-19-000003.txt : 20190807 0001783087-19-000003.hdr.sgml : 20190807 20190807155051 ACCESSION NUMBER: 0001783087-19-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20190807 DATE AS OF CHANGE: 20190807 EFFECTIVENESS DATE: 20190807 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Clever Care Health Plan, Inc. CENTRAL INDEX KEY: 0001783087 IRS NUMBER: 832354214 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-346013 FILM NUMBER: 191005307 BUSINESS ADDRESS: STREET 1: 1040 S. MOUNT VERNON AVENUE STREET 2: SUITE F CITY: COLTON STATE: CA ZIP: 92324 BUSINESS PHONE: 657-221-0285 MAIL ADDRESS: STREET 1: 1040 S. MOUNT VERNON AVENUE STREET 2: SUITE F CITY: COLTON STATE: CA ZIP: 92324 D 1 primary_doc.xml X0708 D LIVE 0001783087 Clever Care Health Plan, Inc. 1040 S. MOUNT VERNON AVENUE SUITE F COLTON CA CALIFORNIA 92324 657-221-0285 DELAWARE None None Corporation true 2018 Dave Firdaus 1040 S. Mount Vernon Avenue Suite F Colton CA CALIFORNIA 92324 Executive Officer Director Hiep Dinh Pham 1040 S. Mount Vernon Avenue Suite F Colton CA CALIFORNIA 92324 Executive Officer Director Myong Sun Lee 1040 S. Mount Vernon Avenue Suite F Colton CA CALIFORNIA 92324 Executive Officer Director Other Health Care No Revenues 06b false 2019-06-28 false true false 0 5722497 3677879 2044618 Total remaining to be sold will be sold upon the Company obtaining certain milestones. false 4 0 0 0 false Clever Care Health Plan, Inc. /s/ Daniel X. Nguyen Daniel Nguyen Attorney-in-Fact 2019-08-07