Statement of Changes in Beneficial Ownership (4)
April 20 2015 - 6:13PM
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
*
DENTINO WILLIAM
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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)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
__
X
__ Other (specify below)
Trustee of trust owners
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(Last)
(First)
(Middle)
3500 DOUGLAS BLVD., SUITE 160
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3. Date of Earliest Transaction
(MM/DD/YYYY)
4/16/2015
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(Street)
ROSEVILLE, CA 95661
(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)
___ Form filed by One Reporting Person
_
X
_ 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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4/16/2015
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S
(1)
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71905
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D
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$64.6301
(2)
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254209
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I
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Trustee
(3)
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Common Stock
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4/17/2015
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S
(1)
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39154
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D
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$63.1374
(4)
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46945
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I
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Executor
(5)
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Common Stock
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4/20/2015
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S
(1)
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30846
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D
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$63.172
(6)
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16099
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I
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Executor
(5)
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Common Stock
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208795
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I
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Trustee
(7)
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Common Stock
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270555
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I
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Trustee
(8)
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Common Stock
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295750
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I
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Trustee
(9)
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Common Stock
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344906
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I
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Trustee
(10)
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Common Stock
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172990
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I
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Trustee
(11)
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Common Stock
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3717550
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I
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Trustee
(12)
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Common Stock
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192705
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I
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Trustee
(13)
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Common Stock
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206719
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I
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Trustee
(14)
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Common Stock
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4090360
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I
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Trustee
(15)
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Common Stock
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300
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D
(16)
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Common Stock
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1496
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D
(17)
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Common Stock
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154291
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I
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Trustee
(18)
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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 a Rule 10b5-1 Trading Plan of the Reporting Person.
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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 $64.23 to $65.13. 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 owned by the MRM GRAT 812/3 of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
4)
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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 $62.54 to $64.38. The Reporting Person undertakes to provide full information about the transactions to the Commission upon request.
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(
5)
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The shares are owned by the Estate of Mary R. Molina, of which Mr. Dentino is executor.
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(
6)
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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 $62.80 to $63.92. The Reporting Person undertakes to provide full information about the transactions to the Comission upon request.
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(
7)
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The shares are owned by MRM GRAT 610/5, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
8)
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The shares are owned by the MRM GRAT 609/7, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
9)
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The shares are owned by MRM GRAT 1210/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
10)
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The shares are owned by MRM GRAT 811/3, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
11)
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The shares are owned by MRM GRAT 610/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
12)
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The shares are owned by the Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
13)
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The shares are owned by the MRM GRAT 1209/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
14)
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The shares are owned by the MRM GRAT 609/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
15)
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The shares are owned by the Molina Marital Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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(
16)
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The shares are owned by Mr. Pedersen.
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(
17)
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The shares are owned by Mr. Dentino.
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(
18)
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The shares are owned by the MRM GRAT 1209/3, of which Mr. Dentino and Mr. Pedersen are co-trustees.
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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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DENTINO WILLIAM
3500 DOUGLAS BLVD., SUITE 160
ROSEVILLE, CA 95661
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X
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Trustee of trust owners
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PEDERSEN CURTIS
6218 EAST 6TH STREET
LONG BEACH, CA 90803
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Trustee of trust owners
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MARY R MOLINA LIVING TRUST
3500 DOUGLAS BLVD., SUITE 160
ROSEVILLE, CA 95661
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X
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MOLINA MARITAL TRUST
3500 DOUGLAS BLVD., SUITE 160
ROSEVILLE, CA 95661
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X
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Signatures
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William Dentino, by Karen Calhoun, Attorney-In-Fact
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4/20/2015
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**
Signature of Reporting Person
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Date
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Curtis Pedersen, by Karen Calhoun, Attorney-In-Fact
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4/20/2015
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**
Signature of Reporting Person
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Date
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William Dentino and Curtis Pedersen, Co-Trustees of the Mary R Molina Living Trust, by Karen Calhoun, Attorney-In-Fact
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4/20/2015
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**
Signature of Reporting Person
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Date
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William Dentino and Curtis Pedersen, Co-Trustees of the Molina Marital Trust, by Karen Calhoun, Attorney-In-Fact
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4/20/2015
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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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