ModivCare Inc.

10/28/2024 | Press release | Distributed by Public on 10/28/2024 18:49

Initial Statement of Beneficial Ownership - Form 3

Ownership Submission
FORM 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549INITIAL 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 *
Khan Faisal
2. Date of Event Requiring Statement (Month/Day/Year)
2024-10-22 		3. Issuer Name and Ticker or Trading Symbol
ModivCare Inc [MODV]
(Last) (First) (Middle)
6900 E. LAYTON AVENUE , 12TH FLOOR
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
Sr VP, General Counsel and Sec /
5. If Amendment, Date Original Filed(Month/Day/Year)
(Street)
DENVER CO 80237
6. Individual or Join/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Beneficially Owned
1.Title of Security 2. Amount of Securities Beneficially Owned 3. Ownership Form: Direct (D) or Indirect (I) 4. Nature of Indirect Beneficial Ownership
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security 2. Date Exercisable and Expiration Date 3. Title and Amount of Securities Underlying Derivative Security 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) 6. Nature of Indirect Beneficial Ownership
Date Exercisable Expriation Date Title Amount or Number of Shares

Reporting Owners

Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Khan Faisal
6900 E. LAYTON AVENUE
12TH FLOOR
DENVER, CO80237

Sr VP, General Counsel and Sec

Signatures

/s/ Faisal Khan 2024-10-28
**Signature of Reporting Person Date

Explanation of Responses:

(*) 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).
(1) Includes an aggregate of 1,723 restricted stock units scheduled to vest as follows: (i) 458 shares will vest on February 14, 2025; (ii) 175 shares will vest on August 31, 2025; (iii) 458 shares will vest on February 14, 2026; (iv) 174 shares will vest on August 31, 2026; and (v) 458 shares will vest on February 14, 2027, in each case, subject to the reporting person's continued employment.
(2) 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 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 August 31, 2026. The number of shares of common stock reported assumes an Adjusted EBITDA performance target achieved that corresponds to a 100% payout level.
(3) 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 Adjusted EBITDA (weighted at 40%) and relative total shareholder return (weighted at 60%) thresholds measured as of December 31, 2026, subject to the reporting person's continued employment through the vesting date of February 14, 2027. The number of shares of common stock reported assumes an Adjusted EBITDA and relative total shareholder return performance target achieved that corresponds to an aggregate 100% payout level.
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.