0001209191-18-003635.txt : 20180116 0001209191-18-003635.hdr.sgml : 20180116 20180116171316 ACCESSION NUMBER: 0001209191-18-003635 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20180111 FILED AS OF DATE: 20180116 DATE AS OF CHANGE: 20180116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DENTINO WILLIAM CENTRAL INDEX KEY: 0001246931 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-31719 FILM NUMBER: 18529254 MAIL ADDRESS: STREET 1: 555 CAPITOL MALL STREET 2: SUITE 1500 CITY: SACRAMENTO STATE: CA ZIP: 95814 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PEDERSEN CURTIS CENTRAL INDEX KEY: 0001246924 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-31719 FILM NUMBER: 18529253 MAIL ADDRESS: STREET 1: 6218 E. 6TH ST CITY: LONG BEACH STATE: CA ZIP: 90803 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MOLINA HEALTHCARE INC CENTRAL INDEX KEY: 0001179929 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 134204626 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 200 OCEANGATE, SUITE 100 CITY: LONG BEACH STATE: CA ZIP: 90802 BUSINESS PHONE: 5624353666 MAIL ADDRESS: STREET 1: 200 OCEANGATE, SUITE 100 CITY: LONG BEACH STATE: CA ZIP: 90802 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-01-11 0 0001179929 MOLINA HEALTHCARE INC MOH 0001246931 DENTINO WILLIAM 3500 DOUGLAS BLVD., SUITE 160 ROSEVILLE CA 95661 0 0 1 1 Trustee and executor 0001246924 PEDERSEN CURTIS 6218 EAST 6TH STREET LONG BEACH CA 90803 0 0 1 1 Trustee Common Stock 2018-01-11 4 S 0 22500 84.883 D 3129292 I Trustee Common Stock 2018-01-12 4 S 0 22500 85.4565 D 3106792 I Trustee Common Stock 2018-01-16 4 S 0 22500 89.7978 D 3084292 I Trustee Common Stock 28258 I Trustee Common Stock 254209 I Trustee Common Stock 47273 I Executor Common Stock 208795 I Trustee Common Stock 239381 I Trustee Common Stock 295750 I Trustee Common Stock 344906 I Trustee Common Stock 172990 I Trustee Common Stock 192705 I Trustee Common Stock 206719 I Trustee Common Stock 300 I Trustee Common Stock 1496 I Trustee Common Stock 154291 I Trustee Sale pursuant to the Rule 10b5-1 Trading Plan of the Mary R Molina Living Trust. Represents the weighted average sale price of all sales on the Transaction Date. The range of prices for the transactions was $84.17 to $86.17. The Reporting Person undertakes to provide full information about the transactions to the Commission upon request. The shares are owned by the Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees. Represents the weighted average sale price of all sales on the Transaction Date. The range of prices for the transactions was $84.61 to $85.83. The Reporting Person undertakes to provide full information about the transactions to the Commission upon request. Represents the weighted average sale price of all sales on the Transaction Date. The range of prices for the transactions was $88.91 to $91.24. The Reporting Person undertakes to provide full information about the transactions to the Commission upon request. The shares are owned by the Exempt Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by the MRM GRAT 812/3 of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by the Estate of Mary R. Molina, of which Mr. Dentino is executor. The shares are owned by MRM GRAT 610/5, of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by the MRM GRAT 609/7, of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by MRM GRAT 1210/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by MRM GRAT 811/3, of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by MRM GRAT 610/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by the MRM GRAT 1209/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by the MRM GRAT 609/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. The shares are owned by the Curtis and Rosi Pedersen 2012 Trust, of which Mr. Pedersen and his spouse are co-trustees. The shares are owned by the Dentino Family Trust, of which Mr. Dentino is sole trustee. The shares are owned by the MRM GRAT 1209/3, of which Mr. Dentino and Mr. Pedersen are co-trustees. See Exhibit 99 for the names, addresses and signatures of Additional Reporting Persons. /s/ William Dentino, by Karen Calhoun, Attorney-In-Fact 2018-01-16 /s/ Curtis Pedersen, by Karen Calhoun, Attorney-In-Fact 2018-01-16 EX-99 2 attachment1.htm EX-99 DOCUMENT

EXHIBIT 99
To William Dentino Form 4


ADDITIONAL REPORTING PERSONS

Owners:

Estate of Mary R. Molina
c/o 3500 Douglas Blvd., Suite 160, Roseville, CA  95661
/s/ William Dentino, Sole Executor, by Karen Calhoun, Attorney-In-Fact

Mary R. Molina Living Trust
Exempt Mary R. Molina Living Trust
Mary R. Molina Grantor Retained Annuity Trust 609/4
Mary R. Molina Grantor Retained Annuity Trust 609/7
Mary R. Molina Grantor Retained Annuity Trust 1209/3
Mary R. Molina Grantor Retained Annuity Trust 1209/4
Mary R. Molina Grantor Retained Annuity Trust 610/4
Mary R. Molina Grantor Retained Annuity Trust 610/5
Mary R. Molina Grantor Retained Annuity Trust 1210/4
Mary R. Molina Grantor Retained Annuity Trust 811/3
Mary R. Molina Grantor Retained Annuity Trust 812/3
c/o 3500 Douglas Blvd., Suite 160, Roseville, CA  95661
/s/ William Dentino and Curtis Pedersen, Co-Trustees, by Karen Calhoun,
Attorney-In-Fact

Dentino Family Trust
c/o 3500 Douglas Blvd., Suite 160, Roseville, CA  95661
/s/ William Dentino, Sole Trustee, by Karen Calhoun, Attorney-In-Fact

Curtis and Rosi Pedersen 2012 Trust
6218 East 6th Street, Long Beach, CA  90803
/s/ Curtis Pedersen and Rosi Pedersen, Co-Trustees, by Karen Calhoun,
Attorney-In-Fact