Statement of Changes in Beneficial Ownership (4)
September 07 2017 - 6:00PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
MOLINA J MARIO MD
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2. Issuer Name
and
Ticker or Trading Symbol
MOLINA HEALTHCARE INC
[
MOH
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
15302 CENTRAL AVENUE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/5/2017
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(Street)
CHINO, CA 91710
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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9/5/2017
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S
(1)
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15000
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D
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$64.746
(2)
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143565
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I
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Trust
(3)
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Common Stock
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419184
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I
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Trust
(4)
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Common Stock
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122956
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I
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Trust
(5)
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Common Stock
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18920
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I
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Trust
(6)
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Common Stock
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18920
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I
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Trust
(7)
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Common Stock
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18920
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I
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Trust
(8)
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Common Stock
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19280
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I
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Trust
(9)
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Common Stock
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42126
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I
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Trust
(10)
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Common Stock
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42126
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I
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Trust
(11)
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Common Stock
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42124
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I
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Trust
(12)
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Common Stock
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28536
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I
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Trust
(13)
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Common Stock
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65282
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I
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Trust
(14)
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Common Stock
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83087
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I
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Trust
(15)
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Common Stock
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83087
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I
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Trust
(16)
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Common Stock
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200000
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I
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Trust
(17)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(1)
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Sale pursuant to the Rule 10b5-1 Trading Plan of Dr. Molina.
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(2)
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Represents the weighted average sale price of all sales on the Transaction Date. The range of prices for the transactions was $63.925 to $65.08. The Reporting Person undertakes to provide full information about the transactions to the Commission upon request.
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(3)
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The shares are held by the M/T Molina Family Trust, of which Dr. Molina and his spouse are trustees and beneficiaries.
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(4)
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The shares are owned by the J. Marion Molina Separate Property Trust, of which Dr. Molina is sole trustee.
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(5)
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The shares are owned by Dr. Molina's spouse, Therese A. Molina, as trustee of the MM GRAT 915/3.
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(6)
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The shares are owned by Dr. Molina, as trustee of the David M.F. Molina Trust No. 2 dated 5/14/2003.
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(7)
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The shares are owned by Dr. Molina, as trustee of the Mary Clare F. Molina Trust No. 2 dated 5/14/2003.
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(8)
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The shares are owned by Dr. Molina, as trustee of the Colleen A.F. Fox Trust No. 2 dated 5/14/2003.
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(9)
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The shares are owned by Dr. Molina, as trustee of the Carley A.F. Fox Trust No. 2 dated 5/14/2003.
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(10)
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The shares are owned by Dr. Molina's spouse, Therese A. Molina, Trustee of the Remainder Trust for David M.F. Molina dated 12/3/2008.
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(11)
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The shares are owned by Dr. Molina's spouse, Therese A. Molina, Trustee of the Remainder Trust for Mary Clare F. Molina dated 12/3/2008.
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(12)
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The shares are owned by Dr. Molina's spouse, Therese A. Molina, Trustee of the Remainder Trust for Colleen A.F. Fox dated 12/3/2008.
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(13)
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The shares are owned by Dr. Molina's spouse, Therese A. Molina, Trustee of the Remainder Trust for Carley F. Fox dated 12/3/2008.
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(14)
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The shares are owned by JMB GRAT 1209/4 for the benefit of Josephine M. Battiste, of which Dr. Molina is sole trustee.
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(15)
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The shares are owned by Dr. Molina, as trustee of the Katherine Rose Battiste Trust IV.
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(16)
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The shares are owned by Dr. Molina, as trustee of the Julius Avery Battiste Trust IV.
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(17)
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The shares are owned by JMM GRAT 716/3, of which Dr. Molina is the beneficiary.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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MOLINA J MARIO MD
15302 CENTRAL AVENUE
CHINO, CA 91710
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X
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Signatures
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/s/ Joseph M. Molina, M.D., by Karen Calhoun, Attorney-in-Fact
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9/7/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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