CO= U= EQUAL EMPLOYMENT OPPORTUNITY GR36268 GR36268 2016 EMPLOYER INFORMATION REPORT CONSOLIDATED REPORT - TYPE 2 SECTION C - TEST FOR FILING REQUIREMENT SECTION B - COMPANY IDENTIFICATION 1. 2.a. CLOVER HEALTH 22 4TH STREET, 5TH FLOOR SAN FRANCISCO, CA 94103 CLOVER HEALTH 22 4TH STREET, 5TH FLOOR SAN FRANCISCO, CA 94103 1-Y 2-Y 3-N DUNS NO.:0 EIN :472580683 SECTION E - ESTABLISHMENT INFORMATION c. NAICS: SECTION D - EMPLOYMENT DATA NOT-HISPANIC OR LATINO HISPANIC OR LATINO JOB CATEGORIES MALE EXECUTIVE/SR OFFICIALS & MGRS * * * * * * * * * * * * MALE * * * * * * * * * * * * FEMALE WHITE BLACK OR AFRICAN AMERICAN NATIVE HAWAIIAN OR PACIFIC ISLANDER * * * * * * * * * * * FEMALE * * * * * * * * * * * AMERICAN INDIAN OR ALASKAN NATIVE ASIAN TWO OR MORE RACES NATIVE BLACK OR HAWAIIAN AFRICAN OR AMERICAN PACIFIC ISLANDER WHITE OVERALL AMERICAN INDIAN OR ALASKAN NATIVE ASIAN TOTALS TWO OR MORE RACES FIRST/MID OFFICIALS & MGRS 2 2 0 6 12 10 1 4 0 0 3 4 0 0 0 0 4 18 31 2 0 0 1 8 0 0 0 3 54 57 PROFESSIONALS 6 4 31 1 10 0 0 2 15 2 0 22 0 3 96 TECHNICIANS SALES WORKERS 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 3 0 ADMINISTRATIVE SUPPORT 9 28 7 6 1 4 0 2 14 2 0 15 0 2 90 CRAFT WORKERS 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 OPERATIVES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LABORERS & HELPERS 0 3 0 15 0 0 0 2 0 0 0 2 0 0 0 0 0 11 0 13 0 0 0 1 0 0 0 0 0 47 22 53 62 14 11 13 0 4 63 50 0 47 0 11 350 SERVICE WORKERS TOTAL PREVIOUS REPORT TOTAL SECTION F - REMARKS DATES OF PAYROLL PERIOD: 07/22/2016 THRU 08/01/2016 SECTION G - CERTIFICATION CERTIFYING OFFICIAL: CARINA IP EEO-1 REPORT CONTACT PERSON: HUMAN RESOURCES EMAIL: HR@CLOVERHEALTH.COM TITLE: HRIS ANALYST TITLE: HR TELEPHONE NO: 6502670395 CERTIFIED DATE[EST]: 10/03/2016 01:33 PM CO= U= EQUAL EMPLOYMENT OPPORTUNITY GR36268 GR36268 2016 EMPLOYER INFORMATION REPORT HEADQUARTERS REPORT - TYPE 3 SECTION C - TEST FOR FILING REQUIREMENT SECTION B - COMPANY IDENTIFICATION 1. 2.a. CLOVER HEALTH 22 4TH STREET, 5TH FLOOR SAN FRANCISCO, CA 94103 CLOVER HEALTH 22 4TH STREET, 5TH FLOOR SAN FRANCISCO, CA 94103 1-Y 2-Y 3-N DUNS NO.:0 EIN :472580683 SAN FRANCISCO COUNTY SECTION E - ESTABLISHMENT INFORMATION c. NAICS: 524114 Direct Health and Medical Insurance Carriers SECTION D - EMPLOYMENT DATA NOT-HISPANIC OR LATINO HISPANIC OR LATINO JOB CATEGORIES MALE EXECUTIVE/SR OFFICIALS & MGRS * * * * * * * * * * * * MALE * * * * * * * * * * * * FEMALE WHITE BLACK OR AFRICAN AMERICAN NATIVE HAWAIIAN OR PACIFIC ISLANDER * * * * * * * * * * * FEMALE * * * * * * * * * * * AMERICAN INDIAN OR ALASKAN NATIVE ASIAN TWO OR MORE RACES NATIVE BLACK OR HAWAIIAN AFRICAN OR AMERICAN PACIFIC ISLANDER WHITE OVERALL AMERICAN INDIAN OR ALASKAN NATIVE ASIAN TOTALS TWO OR MORE RACES FIRST/MID OFFICIALS & MGRS 1 2 0 1 9 9 1 2 0 0 2 4 0 0 0 0 3 14 0 0 0 0 1 8 0 0 0 2 17 42 PROFESSIONALS 6 2 30 1 10 0 0 2 14 1 0 20 0 1 87 TECHNICIANS SALES WORKERS 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 3 0 ADMINISTRATIVE SUPPORT 2 4 5 0 1 1 0 2 13 2 0 9 0 0 39 CRAFT WORKERS 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 OPERATIVES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LABORERS & HELPERS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 7 55 4 11 7 0 4 45 3 0 38 0 6 191 SERVICE WORKERS TOTAL PREVIOUS REPORT TOTAL SECTION F - REMARKS CO= U= EQUAL EMPLOYMENT OPPORTUNITY GR36268 GR52350 2016 EMPLOYER INFORMATION REPORT INDIVIDUAL ESTABLISHMENT REPORT - TYPE 4 SECTION C - TEST FOR FILING REQUIREMENT SECTION B - COMPANY IDENTIFICATION 1. 2.a. CLOVER HEALTH 22 4TH STREET, 5TH FLOOR SAN FRANCISCO, CA 94103 CLOVER HEALTH LLC 3 SECOND STREET PLAZA 10 JERSEY CITY, NJ 07311 HUDSON COUNTY 1-Y 2-Y 3-N DUNS NO.:0 EIN :383889370 SECTION E - ESTABLISHMENT INFORMATION c. NAICS: 524114 Direct Health and Medical Insurance Carriers SECTION D - EMPLOYMENT DATA NOT-HISPANIC OR LATINO HISPANIC OR LATINO JOB CATEGORIES MALE EXECUTIVE/SR OFFICIALS & MGRS * * * * * * * * * * * * MALE * * * * * * * * * * * * FEMALE WHITE BLACK OR AFRICAN AMERICAN NATIVE HAWAIIAN OR PACIFIC ISLANDER * * * * * * * * * * * FEMALE * * * * * * * * * * * AMERICAN INDIAN OR ALASKAN NATIVE ASIAN TWO OR MORE RACES NATIVE BLACK OR HAWAIIAN AFRICAN OR AMERICAN PACIFIC ISLANDER WHITE OVERALL AMERICAN INDIAN OR ALASKAN NATIVE ASIAN TOTALS TWO OR MORE RACES FIRST/MID OFFICIALS & MGRS 1 0 0 5 3 1 0 2 0 0 1 0 0 0 0 0 1 4 31 2 0 0 0 0 0 0 0 1 37 15 PROFESSIONALS 0 2 1 0 0 0 0 0 1 1 0 2 0 2 9 TECHNICIANS SALES WORKERS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ADMINISTRATIVE SUPPORT 7 24 2 6 0 3 0 0 1 0 0 6 0 2 51 CRAFT WORKERS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OPERATIVES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LABORERS & HELPERS 0 3 0 15 0 0 0 2 0 0 0 2 0 0 0 0 0 11 0 13 0 0 0 1 0 0 0 0 0 47 11 46 7 10 0 6 0 0 18 47 0 9 0 5 159 SERVICE WORKERS TOTAL PREVIOUS REPORT TOTAL SECTION F - REMARKS