SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/16/2023 |
3. Issuer Name and Ticker or Trading Symbol
agilon health, inc. [ AGL ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 11,518(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Options (Right to buy) | (2) | 07/29/2030 | Common Stock | 17,500 | 4.5 | D | |
Options (Right to buy) | (3) | 07/29/2030 | Common Stock | 26,250 | 8.99 | D | |
Options (Right to buy) | (4) | 04/14/2031 | Common Stock | 2,035 | 23 | D | |
Options (Right to buy) | (5) | 04/14/2032 | Common Stock | 2,854 | 23.07 | D | |
Options (Right to buy) | (6) | 05/24/2032 | Common Stock | 4,326 | 18.8 | D |
Explanation of Responses: |
1. Includes 10,396 restricted stock units that vest in four equal installments on each anniversary of April 14, 2021, April 14, 2022, May 24, 2022 or April 14, 2023, subject to continued employment. |
2. These options were granted on July 29, 2020, and vest in four equal installments on each anniversary of June 29, 2020, subject to continued employment. |
3. These options were granted on July 29, 2020, and vest in four equal installments on each of September 14, 2021, June 29, 2022, June 29, 2023, and June 29, 2024, subject to continued employment. |
4. These options were granted on April 14, 2021, and vest in four equal installments on each anniversary of April 14, 2021, subject to continued employment. |
5. These options were granted on April 14, 2022, and vest in four equal installments on each anniversary of April 14, 2022, subject to continued employment. |
6. These options were granted on May 24, 2022, and vest in four equal installments on each anniversary of May 24, 2022, subject to continued employment. |
Remarks: |
Exhibit List: Ex.24 - Power of Attorney |
/s/ Steve Meetre, as Attorney-in-Fact | 08/18/2023 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |