0001437749-21-004708.txt : 20210302 0001437749-21-004708.hdr.sgml : 20210302 20210302163736 ACCESSION NUMBER: 0001437749-21-004708 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210226 FILED AS OF DATE: 20210302 DATE AS OF CHANGE: 20210302 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Sampson L Heath CENTRAL INDEX KEY: 0001618774 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34221 FILM NUMBER: 21704326 MAIL ADDRESS: STREET 1: C/O ADVANCED EMISSIONS SOLUTIONS, INC. STREET 2: 9135 S RIDGELINE BLVD STE 200 CITY: HIGHLANDS RANCH STATE: CO ZIP: 80129 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ModivCare Inc CENTRAL INDEX KEY: 0001220754 STANDARD INDUSTRIAL CLASSIFICATION: TRANSPORTATION SERVICES [4700] IRS NUMBER: 860845127 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4700 SOUTH SYRACUSE STREET STREET 2: 4TH FLOOR CITY: DENVER STATE: CO ZIP: 80237 BUSINESS PHONE: 203-307-2800 MAIL ADDRESS: STREET 1: 4700 SOUTH SYRACUSE STREET STREET 2: 4TH FLOOR CITY: DENVER STATE: CO ZIP: 80237 FORMER COMPANY: FORMER CONFORMED NAME: PROVIDENCE SERVICE CORP DATE OF NAME CHANGE: 20030226 3 1 rdgdoc.xml FORM 3 X0206 3 2021-02-26 1 0001220754 ModivCare Inc MODV 0001618774 Sampson L Heath 4700 SOUTH SYRACUSE STREET 4TH FLOOR DENVER CO 80237 1 Chief Financial Officer Exhibit Index: Exhibit 24 - Power of Attorney for L. Heath Sampson dated February 26, 2021 /s/ Jonathan B. Bush by Power of Attorney 2021-03-02 EX-24 2 ex_231304.htm ex_231304.htm

Exhibit 24

 

POWER OF ATTORNEY

 

Know all by these presents, that the undersigned hereby constitutes and appoints Kathryn Stalmack and Jonathan B. Bush, either of them acting singly and with full power of substitution, as his or her true and lawful attorney-in-fact to:

 

 

(1)

execute for and on behalf of the undersigned, in the undersigned’s capacity as an officer or director or both of The Providence Service Corporation (the “Company”), Forms 3, 4 and 5 (and any amendments thereto), as a result of the undersigned's ownership of or transactions in the Company’s securities, in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”) and the rules thereunder;

 

 

(2)

do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete the execution of any such Form 3, 4 or 5 (and any amendments thereto), and the timely filing of such form with the Securities and Exchange Commission and any securities exchange or similar authority; and

 

 

(3)

take any other action in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by or for, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in his or her discretion.

 

The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act required, necessary and proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or his or her substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted.

 

The authority under this Power of Attorney shall continue until the undersigned is no longer required to file Forms 3, 4 and 5 with regard to the undersigned's ownership of or transactions in securities of the Company, unless earlier revoked by the undersigned in writing. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request and on behalf of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with, or any liability for the failure to comply with, Section 16 of the Exchange Act.

 

The undersigned hereby revokes any and all powers of attorney executed prior to the date hereof which purport to appoint attorneys-in-fact to act on the undersigned’s behalf in connection with the execution and filing of Forms 3, 4 and 5 with regard to the securities of the Company.

 

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 26th day of February, 2021.

 

 

  /s/ L. Heath Sampson  
  Signature  
     
  L. Heath Sampson  
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