0001209191-21-027014.txt : 20210416 0001209191-21-027014.hdr.sgml : 20210416 20210416172440 ACCESSION NUMBER: 0001209191-21-027014 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210414 FILED AS OF DATE: 20210416 DATE AS OF CHANGE: 20210416 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dombro Lisa CENTRAL INDEX KEY: 0001855954 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40332 FILM NUMBER: 21832442 MAIL ADDRESS: STREET 1: C/O AGILON HEALTH, INC. STREET 2: 1 WORLD TRADE CENTER, SUITE 2000 CITY: LONG BEACH STATE: CA ZIP: 90831 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: agilon health, inc. CENTRAL INDEX KEY: 0001831097 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 371915147 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1 WORLD TRADE CENTER STREET 2: SUITE 2000 CITY: LONG BEACH STATE: CA ZIP: 90831 BUSINESS PHONE: 562-256-3800 MAIL ADDRESS: STREET 1: 1 WORLD TRADE CENTER STREET 2: SUITE 2000 CITY: LONG BEACH STATE: CA ZIP: 90831 FORMER COMPANY: FORMER CONFORMED NAME: Agilon Health Topco, Inc. DATE OF NAME CHANGE: 20201103 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-04-14 0 0001831097 agilon health, inc. AGL 0001855954 Dombro Lisa C/O AGILON HEALTH, INC. 1 WORLD TRADE CENTER, SUITE 2000 LONG BEACH CA 90831 0 1 0 0 Exper. & Innovation Officer Common Stock 2021-04-14 4 A 0 11956 0.00 A 11956 D Options (Rights to Buy) 23.00 2021-04-14 4 A 0 40710 0.00 A 2031-04-14 Common Stock 40710 40710 D Restricted stock units that vest in four equal installments on each anniversary of April 14, 2021, subject to continued employment. Options that vest in four equal installments on each anniversary of April 14, 2021, subject to continued employment. /s/ Lyn Amor Macaraeg, as Attorney-in-Fact 2021-04-16