SEC Contract Filing

Filing Date: 2019-12-31

Document Content:
<DOCUMENT>
<TYPE>EX-10.4
<SEQUENCE>6
<FILENAME>exhibit104passportwarr.htm
<DESCRIPTION>EXHIBIT 10.4
<TEXT>
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<div><a name="s98E77AF450B8C3A9B70E5937BC2E8611"></a></div><div><div style="line-height:120%;text-align:right;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">EXHIBIT 10.4</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div></div><div><br></div><div style="line-height:132%;padding-bottom:8px;padding-top:6px;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">THIS WARRANT AND THE SHARES ISSUABLE </font><font style="font-family:inherit;font-size:12pt;">UPON EXERCISE OF THIS WARRANT HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE &#8220;</font><font style="font-family:inherit;font-size:12pt;font-weight:bold;">SECURITIES ACT</font><font style="font-family:inherit;font-size:12pt;">&#8221;), AND MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED EXCEPT IN ACCORDANCE WITH THE TERMS HEREOF AND THE FOLLOWING SENTENCE. BY ITS ACQUISITION HEREOF OR OF A BENEFICIAL INTEREST HEREIN, THE HOLDER: (1) REPRESENTS THAT IT IS, AND WILL BE AT THE TIME OF ANY EXERCISE OF THIS WARRANT, AN ACCREDITED INVESTOR WITHIN THE MEANING OF REGULATION D AS PROMULGATED UNDER THE SECURITIES ACT, AND (2)&#160;AGREES FOR THE BENEFIT OF EVOLENT HEALTH, INC. (THE &#8220;</font><font style="font-family:inherit;font-size:12pt;font-weight:bold;">COMPANY</font><font style="font-family:inherit;font-size:12pt;">&#8221;) THAT IT WILL NOT OFFER, SELL, PLEDGE OR OTHERWISE TRANSFER THIS WARRANT OR ANY OF THE SHARES, IF ANY, ISSUABLE UPON EXERCISE OF THIS WARRANT OR ANY BENEFICIAL INTEREST HEREIN OR THEREIN EXCEPT: (A) TO THE COMPANY OR ANY SUBSIDIARY THEREOF, OR (B) PURSUANT TO A REGISTRATION STATEMENT WHICH HAS BECOME EFFECTIVE UNDER THE SECURITIES ACT, OR (C) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT.</font></div><div style="line-height:132%;padding-bottom:8px;padding-top:6px;text-align:justify;padding-left:6px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:8px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">EVOLENT HEALTH, INC.</font></div><div style="line-height:120%;padding-bottom:8px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">FORM OF WARRANT</font></div><div style="line-height:120%;padding-bottom:8px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">_____________ Shares of Class A Common Stock</font></div><div style="line-height:120%;padding-bottom:8px;text-align:justify;text-indent:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:8px;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">Warrant No.: CA-__&#160;&#160;&#160;&#160;December 30, 2019</font></div><div style="line-height:120%;padding-bottom:8px;text-align:justify;text-indent:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:8px;text-align:justify;text-indent:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">This </font><font style="font-family:inherit;font-size:12pt;font-weight:bold;">WARRANT</font><font style="font-family:inherit;font-size:12pt;">&#32;(this &#8220;</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Warrant</font><font style="font-family:inherit;font-size:12pt;">&#8221;) of </font><font style="font-family:inherit;font-size:12pt;font-weight:bold;">EVOLENT HEALTH, INC.</font><font style="font-family:inherit;font-size:12pt;">, a Delaware corporation (the &#8220;</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Company</font><font style="font-family:inherit;font-size:12pt;">&#8221;), is being executed and delivered in connection with that certain Credit Agreement, dated as of December 30, 2019 (as the same may be amended, restated, supplemented and/or modified from time to time, the &#8220;</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Credit Agreement</font><font style="font-family:inherit;font-size:12pt;">&#8221;), by and among the Company, _______________, a ____________ (the &#8220;</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Holder</font><font style="font-family:inherit;font-size:12pt;">&#8221;), and the other parties thereto, and is for the purchase of shares of the Class A Common Stock, par value $0.01 per share (the &#8220;</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Common Stock</font><font style="font-family:inherit;font-size:12pt;">&#8221;), of the Company. Any capitalized terms used herein without definition shall have the meanings specified in </font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Section 1</font><font style="font-family:inherit;font-size:12pt;">&#32;below.</font></div><div style="line-height:120%;padding-bottom:8px;text-align:justify;text-indent:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">FOR VALUE RECEIVED</font><font style="font-family:inherit;font-size:12pt;">, the Company hereby grants to the Holder the right to purchase from the Company up to an aggregate of </font><font style="font-family:inher