-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, JWlxkLiHedUzXIFx2BXXWGT6Z+8L69bEHYRn5BOtYSrRPWwW1cq8ZPU2i+Rag2Bm jww155mAj83x8ozUMv63qw== 0001181431-04-005508.txt : 20040130 0001181431-04-005508.hdr.sgml : 20040130 20040130175829 ACCESSION NUMBER: 0001181431-04-005508 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040129 FILED AS OF DATE: 20040130 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KULICH ROMAN CENTRAL INDEX KEY: 0001246727 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-31719 FILM NUMBER: 04557112 BUSINESS ADDRESS: STREET 1: C/O MOLINA HEALTHCARE OF MICHIGAN STREET 2: 100 WEST BIG BEAVER, SUITE 600 CITY: TROY STATE: MI ZIP: 48084 MAIL ADDRESS: STREET 1: C/O MOLINA HEALTHCARE OF MICHIGAN STREET 2: 100 WEST BIG BEAVER, SUITE 600 CITY: TROY STATE: MI ZIP: 48084 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: ONE GOLDEN SHORE DRIVE CITY: LONG BEACH STATE: CA ZIP: 90802 BUSINESS PHONE: 5624353666 MAIL ADDRESS: STREET 1: ONE GOLDEN SHORE DRIVE CITY: LONG BEACH STATE: CA ZIP: 90802 4 1 rrd30853.xml X0201 4 2004-01-29 0 0001179929 MOLINA HEALTHCARE INC MOH 0001246727 KULICH ROMAN C/O MOLINA HEALTHCARE, INC. ONE GOLDEN SHORE DRIVE LONG BEACH CA 90802 0 1 0 0 President & CEO of Subsidiary Common Stock 2004-01-29 4 X 0 5000 4.50 A 6154 D Common Stock 2004-01-29 4 S 0 5000 25.70 D 1154 D Common Stock 2004-01-30 4 X 0 20000 4.50 A 21154 D Common Stock 2004-01-30 4 S 0 20000 25.75 D 1154 D Stock Option (Right to Buy) 4.50 2004-01-29 4 X 0 5000 0 D 2011-10-29 Common Stock 5000 39440 D Stock Option (Right to Buy) 4.50 2004-01-30 4 X 0 20000 0 D 2011-10-29 Common Stock 20000 19440 D The sales reported on this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on December 30, 2003. The sales reported on this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on December 30, 2003. Options became fully exercisable upon the closing of the initial public offering of Molina Healthcare, Inc. Prior thereto, options to purchase the shares vested as to (i) 14,665 shares on 4/7/2003; (ii) 14,665 shares on 4/7/2004; and (iii) 15,110 shares on 4/7/2005. Options became fully exercisable upon the closing of the initial public offering of Molina Healthcare, Inc. Prior thereto, options to purchase the shares vested as to (i) 14,665 shares on 4/7/2003; (ii) 14,665 shares on 4/7/2004; and (iii) 15,110 shares on 4/7/2005. Roman Kulich, by Nicholas Arbuckle, Attorney-In-Fact 2004-01-30 -----END PRIVACY-ENHANCED MESSAGE-----