FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
MOLINA HEALTHCARE INC [ MOH ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 09/15/2017 | ||||||||||||||||||||||||||
4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 143,565 | I | Trust(1) | |||||||
Common Stock | 419,184 | I | Trust(2) | |||||||
Common Stock | 122,956 | I | Trust(3) | |||||||
Common Stock | 09/15/2017 | J(4) | 18,920 | D | $0.00(5) | 0 | I | Trust(6) | ||
Common Stock | 09/15/2017 | J(4) | 18,920 | D | $0.00(5) | 0 | I | Trust(7) | ||
Common Stock | 09/15/2017 | J(4) | 18,920 | D | $0.00(5) | 0 | I | Trust(8) | ||
Common Stock | 09/15/2017 | J(4) | 19,280 | D | $0.00(5) | 0 | I | Trust(9) | ||
Common Stock | 09/15/2017 | J(4) | 42,126 | D | $0.00(5) | 0 | I | Trust(10) | ||
Common Stock | 09/15/2017 | J(4) | 42,126 | D | $0.00(5) | 0 | I | Trust(11) | ||
Common Stock | 09/15/2017 | J(4) | 42,124 | D | $0.00(5) | 0 | I | Trust(12) | ||
Common Stock | 09/15/2017 | J(4) | 28,536 | D | $0.00 | 0 | I | Trust(13) | ||
Common Stock | 65,282 | I | Trust(14) | |||||||
Common Stock | 09/15/2017 | J(4) | 83,087 | D | $0.00(5) | 0 | I | Trust(15) | ||
Common Stock | 09/15/2017 | J(4) | 83,087 | D | $0.00(5) | 0 | I | Trust(16) | ||
Common Stock | 200,000 | I | Trust(17) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. The shares are held by the M/T Molina Family Trust, of which Dr. Molina and his spouse are trustees and beneficiaries. |
2. The shares are owned by the J. Marion Molina Separate Property Trust, of which Dr. Molina is sole trustee. |
3. The shares are owned by Dr. Molina's spouse, Therese A. Molina, as trustee of the MM GRAT 915/3. |
4. On September 15, 2017 the Trustee resigned and was replaced with a corporate trustee. |
5. Price not applicable to resignation of trustee. |
6. The shares are owned by Dr. Molina, as trustee of the David M.F. Molina Trust No. 2 dated 5/14/2003. |
7. The shares are owned by Dr. Molina, as trustee of the Mary Clare F. Molina Trust No. 2 dated 5/14/2003. |
8. The shares are owned by Dr. Molina, as trustee of the Colleen A.F. Fox Trust No. 2 dated 5/14/2003. |
9. The shares are owned by Dr. Molina, as trustee of the Carley A.F. Fox Trust No. 2 dated 5/14/2003. |
10. 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. |
11. 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. |
12. 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. |
13. 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. |
14. The shares are owned by JMB GRAT 1209/4 for the benefit of Josephine M. Battiste, of which Dr. Molina is sole trustee. |
15. The shares are owned by Dr. Molina, as trustee of the Katherine Rose Battiste Trust IV. |
16. The shares are owned by Dr. Molina, as trustee of the Julius Avery Battiste Trust IV. |
17. The shares are owned by JMM GRAT 716/3, of which Dr. Molina is the beneficiary. |
Remarks: |
/s/ Joseph M. Molina, M.D., by Karen Calhoun, Attorney-in-Fact | 09/19/2017 | |
** 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 4 (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. |