SEC Form 4 · accession 0001628908-18-000004
Evolent Health, Inc. · EVH
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Seth Blackley
Officer — President
Period of report
Feb 1, 2018
Accepted (ET)
Feb 5, 2018 · 4:59 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 StockF1,F2,F3 | Feb 1, 2018 | A | 86,022 | $0.00 | A | 488,227 | D |
Table II — derivative securities
| 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)F4 | $13.95 | Feb 1, 2018 | A | 101,010 | A | — | Feb 1, 2028 | Class A Common Stock | 101,010 | 101,010 | D |
Explanation of responses
- 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 February 1, 2019.
- F3Includes restricted stock units under awards reported on Table 1 of Form 4s previously filed with the Securities and Exchange Commission.
- F4Securities vest at a rate of 25% annually beginning February 1, 2019.