Schedule 13G

-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, WhSg8oBdOfSf6DHRg7vEvu007ByKbhqSzcLFMKDzUD7i/E+W42rWvE0LjYCInO3Z 8WIxhUpD6X+7KKgUUQjziw== 0001193125-04-024955.txt : 20040217 0001193125-04-024955.hdr.sgml : 20040216 20040217152022 ACCESSION NUMBER: 0001193125-04-024955 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040217 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: MCCUSKER FLETCHER JAY CENTRAL INDEX KEY: 0001256570 FILING VALUES: FORM TYPE: SC 13G MAIL ADDRESS: STREET 1: 5524 EAST FOURTH STREET CITY: TUCSON STATE: AZ ZIP: 85711 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PROVIDENCE SERVICE CORP CENTRAL INDEX KEY: 0001220754 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SOCIAL SERVICES [8300] IRS NUMBER: 860845127 STATE OF INCORPORATION: DE FISCAL YEAR END: 0629 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-79536 FILM NUMBER: 04608068 BUSINESS ADDRESS: STREET 1: 5524 E. FOURTH ST. CITY: TUSCON STATE: AZ ZIP: 85711 BUSINESS PHONE: 5207487108 MAIL ADDRESS: STREET 1: 5524 E. FOURTH ST. CITY: TUSCON STATE: AZ ZIP: 85711 SC 13G 1 dsc13g.htm SCHEDULE 13G Schedule 13G


OMB APPROVAL

OMB Number:		3235-0145

Expires:		December 31, 2005

Estimated average burden
hours per response . . . 11

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

SCHEDULE 13G

Under the Securities Exchange Act of 1934

(Amendment No. )*

The Providence Service Corporation

(Name of Issuer)

Common Stock

(Title of Class of Securities)

743815 10 2

(CUSIP Number)

12/ 31 /03

(Date of Event Which Requires Filing of this Statement)

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

¨ Rule 13d-1(b)

¨ Rule 13d-1(c)

x Rule 13d-1(d)

* The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

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 control number.

SEC 1745 (12-02)

CUSIP No.



1.		Names of Reporting Persons. I.R.S. Identification Nos. of above persons (entities only). Fletcher J. McCusker

2.		Check the Appropriate Box if a Member of a Group (See Instructions) (a) ¨ (b) ¨

3.		SEC Use Only

4.		Citizenship or Place of Organization United States

NUMBER OF

BENEFICIALLY

OWNED BY

EACH

REPORTING

PERSON

WITH:

5. Sole Voting Power

519,898

6. Shared Voting Power

7. Sole Dispositive Power

519,898

8. Shared Dispositive Power


9.		Aggregate Amount Beneficially Owned by Each Reporting Person 519,898

10.		Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) ¨

11.		Percent of Class Represented by Amount in Row (9) 6.2%

12.		Type of Reporting Person (See Instructions) IN

Item 1.

(a)

Name of Issuer

The Providence Service Corporation

(b)

Address of Issuer’s Principal Executive Offices

5524 East Fourth Street

Tucson, AZ 85711

Item 2.

(a)

This Statement is filed by:

Fletcher J. McCusker

(b)

The business address is 5524 East Fourth Street, Tucson, AZ 85711

(c)

Mr. McCusker is a citizen of the United States.

(d)

Title of Class of Securities

Common Stock

(e)

CUSIP Number

7438 15 10 2

Item 3.

N/A

Item 4. Ownership

Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1.

(a)

Amount beneficially owned: 519,898¹

(b)

Percent of class: 6.2%²

(c)

Number of shares as to which the person has:

(i)

Sole power to vote or to direct the vote: 519,898.

(ii)

Shared power to vote or to direct the vote: 0.

(iii)

Sole power to dispose or to direct the disposition of: 519,898.

(iv)

Shared power to dispose or to direct the disposition of: 0.

Based upon 8,346,338 shares of common stock outstanding as reported in the issuer’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2003 and filed with the Securities and Exchange Commission on November 12, 2003.

This amount does not include 47,450 shares of common stock of The Providence Service Corporation held in The Fletcher J. McCusker 2003 GRAT, a grantor retained annuity trust, because Mr. McCusker does not have or share voting power or investment power over such shares and therefore does not beneficially own such shares under Rule 13d-3 or for purposes of Section 13(g) of the Act.

Item 5. Ownership of Five Percent or Less of a Class

N/A

Item 6. Ownership of More than Five Percent on Behalf of Another Person

N/A

Item 7.

Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company

N/A

Item 8.

Identification and Classification of Members of the Group

N/A

Item 9.

Notice of Dissolution of Group

N/A

Item 10.

Certification

N/A

SIGNATURE

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

Dated: February 17, 2004

/s/ Fletcher J. McCusker

Fletcher J. McCusker

-----END PRIVACY-ENHANCED MESSAGE-----