SEC Form 4 · accession 0001140361-16-056450

Evolent Health, Inc. · EVH

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — President

Period of report

Mar 1, 2016

Accepted (ET)

Mar 3, 2016 · 7:24 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001628908

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Class A Common Stock^F1,F2	Mar 1, 2016	A	31,646	$0.00	A	823,646	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Class A Common Stock Option (right to buy)^F3	$10.27	Mar 1, 2016	A	70,324	A	—	Mar 1, 2026	Class A Common Stock	70,324	866,849	D
Class A Common Stock Option (right to buy)^F4	$13.35	Mar 1, 2016	A	35,162	A	—	Mar 1, 2026	Class A Common Stock	35,162	866,849	D
Class A Common Stock Option (right to buy)^F4	$16.43	Mar 1, 2016	A	35,162	A	—	Mar 1, 2026	Class A Common Stock	35,162	866,849	D
Class A Common Stock Option (right to buy)^F4	$19.51	Mar 1, 2016	A	35,161	A	—	Mar 1, 2026	Class A Common Stock	35,161	866,849	D

F1Represents restricted stock units granted to Mr. Blackley pursuant to the Evolent Health, Inc. 2015 Omnibus Incentive Compensation Plan.
F2Securities vest at a rate of 25% annually beginning March 1, 2017.
F3Securities vest at a rate of 25% annually beginning March 1, 2017.
F4Securities cannot vest before the 3rd anniversary of the grant date. No more than 50% of the securities may vest between the 3rd and 4th anniversaries of the grant date. There is unlimited vesting of the securities after the 4th anniversary of the grant date.