Parth Mehrotra - 31 Dec 2021 Form 5 Insider Report for Privia Health Group, Inc. (PRVA)

Role
President and COO
Signature
/s/ Thomas Bartrum, attorney-in-fact
Issuer symbol
PRVA
Transactions as of
31 Dec 2021
Net transactions value
$0
Form type
5
Filing time
14 Feb 2022, 08:56:38 UTC
Previous filing
23 Dec 2021
Next filing
14 Feb 2022
SEC
View on sec.gov

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
transaction PRVA Stock Option (Right to Purchase) Gift $0 -339,197 -45% $0.000000 411,906 24 Sep 2021 Common Stock 339,197 $2.00 Direct F1, F2, F3
transaction PRVA Stock Option (Right to Purchase) Gift $0 -104,216 -60% $0.000000 69,478 24 Sep 2021 Common Stock 104,216 $2.00 Direct F1, F2, F4
transaction PRVA Stock Option (Right to Purchase) Gift $0 +339,197 $0.000000 339,197 24 Sep 2021 Common Stock 339,197 $2.00 By the Parth Mehrotra 2021 Trust F1, F2
transaction PRVA Stock Option (Right to Purchase) Gift $0 +104,216 $0.000000 104,216 24 Sep 2021 Common Stock 104,216 $2.00 By the Parth Mehrotra 2021 Trust F1, F2
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 On September 24, 2021, the reporting person transferred options to purchase shares of the Issuer's common stock to a trust of which the spouse of the reporting person is trustee. The reporting person's spouse and children are the sole beneficiaries of the trust.
F2 All of the transferred stock options are fully vested and exercisable.
F3 139,330 of the stock options are fully vested and exercisable. 46,445 of the stock options will vest and become exercisable on December 4, 2022, 113,065 of the stock options will vest and become exercisable on the 12 month anniversary of the Issuer's initial public offering and 113,067 of the stock options will vest and become exercisable on the 18 month anniversary of the Issuer's initial public offering.
F4 34,739 of the stock options will vest and become exercisable on the 12 month anniversary of the Issuer's initial public offering and 34,739 of the stock options will vest and become exercisable on the 18 month anniversary of the Issuer's initial public offering.