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