Form D
View Original Filing
Notice of Exempt Offering of Securities
Item 1. Issuer's Identity
Name of Issuer:
EVOLENT HEALTH, INC.
Jurisdiction of Incorporation/Organization
DELAWARE
Year of Incorporation/Organization
Over Five Years Ago
Item 2 Issuer Principal Place of Business and Contact Information
800 NORTH GLEBE RD, SUITE 500
ARLINGTON, VA 22203
Phone Number:
subscription required
Item 3. Related Persons
Name
JONATHAN WEINBERG
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
FRANK WILLIAMS
Address
subscription required
Relationship(s)
- EXECUTIVE OFFICER
- DIRECTOR
Clarification of Response
Item 3. Related Persons
Name
TUNDE SOTUNDE
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
DAVID FARNER
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
CRAIG BARBAROSH
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
BRIDGET DUFFY
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
PETER GRUA
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
DIANE HOLDER
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
KIM KECK
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
CHERYL SCOTT
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
SETH BLACKLEY
Address
subscription required
Relationship(s)
- EXECUTIVE OFFICER
- DIRECTOR
Clarification of Response
Item 3. Related Persons
Name
JOHN JOHNSON
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
STEVE TUTEWOHL
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
AAMMAAD SHAMS
Address
subscription required
Relationship(s)
Clarification of Response
Item 4. Industry Group
OTHER
Item 5. Issuer Size
Revenue Range (for issuer not specifying "hedge" or "other investment" fund in Item 4 above)
DECLINE TO DISCLOSE
Item 6. Federal Exemptions and Exclusions Claimed
Item 7. Type of Filing
New Notice
Date of First Sale in this Offering:
11/15/2021
Item 8. Duration of Offering
Does the issuer intend this offering to last more than one year?
No
Item 9. Type(s) of Securities Offered
Item 10. Business Combination Transaction
Is this offering being made in connection with a business combination
transaction, such as a merger, acquisition or exchange offer?
Yes
Clarification of Response
OFFERING IS IN CONNECTION WITH AN EARN-OUT ASSOCIATED WITH A TRANSACTION WITH THE ACCOUNTABLE CARE ORGANIZATION LTD.
Item 11. Minimum Investment
Minimum Investment accepted from any outside investor
0
Item 13. Offering and Sales Amounts
Total Offering Amount
450000
Total Amount Sold
450000
Total Remaining to be Sold
0
Clarification of Response
Item 14. Investors
Securities in the offering have been or may be sold to persons
who do not qualify as accredited investors,
Number of non-accredited investors who already have invested in the offering:
Total number of investors who already have invested in the offering:
18
Item 15. Sales Commissions and Finders' Fees Expenses
Sales Commissions:
0.0
Finders' Fees
0.0
Clarification of Response
Item 16. Use of Proceeds
Provide the amount of the gross proceeds of the offering
that has been or is proposed to be used for payments to any of the persons required
to be named as executive officers,directors or promoters in response to Item 3 above.
0.0
Clarification of Response
Signature and Submission
Issuer Name
EVOLENT HEALTH, INC.
Issuer Signature
/S/ JONATHAN WEINBERG
Signer Name
JONATHAN WEINBERG
Signer Title
GENERAL COUNSEL AND SECRETARY
Signature Date
11/30/2021