| FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 08/19/2022 | 3. Issuer Name and Ticker or Trading Symbol ModivCare Inc [ MODV ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
| Common Stock | 705(1) | D | |
| Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Employee Stock Option (Right to Buy) | (2) | 02/10/2026 | Common Stock | 232 | 179.24 | D | |
| Employee Stock Option (Right to Buy) | (3) | 08/11/2026 | Common Stock | 142 | 179.52 | D | |
| Employee Stock Option (Right to Buy) | (4) | 02/07/2027 | Common Stock | 424 | 106.28 | D | |
| Explanation of Responses: |
| 1. Represents 71 shares of common stock and 634 restricted stock units, which are scheduled to vest as follows: (1) 138 shares will vest on February 7, 2023, (2) 67 shares will vest on February 10, 2023, (3) 43 shares will vest on August 11, 2023, (4) 138 shares will vest on February 7, 2024, (5) 66 shares will vest on February 10, 2024, (6) 44 shares will vest on August 11, 2024 and (7) 138 shares will vest on February 7, 2025, in each case, subject to the reporting person's continued employment. |
| 2. 77 Options are exercisable, the remainder become exercisable with respect to: (1) 78 shares on February 10, 2023 and (2) 77 shares on February 10, 2024, in each case, subject to the reporting person's continued employment. |
| 3. 47 Options are exercisable, the remainder become exercisable with respect to: (1) 48 shares on August 11, 2023 and (2) 47 shares on August 11, 2024, in each case, subject to the reporting person's continued employment. |
| 4. Option becomes exercisable with respect to: (1) 141 shares on February 7, 2023, (2) 142 shares on February 7, 2024 and (3) 141 shares on February 7, 2025, in each case, subject to the reporting person's continued employment. |
| Remarks: |
| Exhibit Index: Exhibit 24 - Power of Attorney |
| /s/ Jonathan B. Bush by Power of Attorney | 09/01/2022 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| 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 Number. | ||
