0001437749-23-005800.txt : 20230308
0001437749-23-005800.hdr.sgml : 20230308
20230308163024
ACCESSION NUMBER: 0001437749-23-005800
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230306
FILED AS OF DATE: 20230308
DATE AS OF CHANGE: 20230308
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sampson L Heath
CENTRAL INDEX KEY: 0001618774
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-34221
FILM NUMBER: 23716532
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: 6900 LAYTON AVENUE
STREET 2: 12TH FLOOR
CITY: DENVER
STATE: CO
ZIP: 80237
BUSINESS PHONE: 303-728-7030
MAIL ADDRESS:
STREET 1: 6900 LAYTON AVENUE
STREET 2: 12TH FLOOR
CITY: DENVER
STATE: CO
ZIP: 80237
FORMER COMPANY:
FORMER CONFORMED NAME: PROVIDENCE SERVICE CORP
DATE OF NAME CHANGE: 20030226
4
1
rdgdoc.xml
FORM 4
X0306
4
2023-03-06
0001220754
ModivCare Inc
MODV
0001618774
Sampson L Heath
6900 LAYTON AVENUE
12TH FLOOR
DENVER
CO
80237
1
1
President, CEO, CFO
Performance Restricted Stock Units
2023-03-06
4
A
0
1022
0
A
2026-03-06
Common Stock
1022
1022
D
Represents the contingent right to receive a number of shares of issuer common stock determined by multiplying the number of performance units by a percentage from 50% to 200% that corresponds to specified revenue and Adjusted EBITDA thresholds measured by reference to the issuer's audited financial statements for its fiscal year ending December 31, 2025, subject to the reporting person's continued employment through the vesting date of March 6, 2026. The number of shares of common stock reported assumes a revenue and Adjusted EBITDA performance target achieved that corresponds to a 100% payout level.
/s/ Jonathan Bush by Power of Attorney
2023-03-08