0001209191-12-017379.txt : 20120312 0001209191-12-017379.hdr.sgml : 20120310 20120312094834 ACCESSION NUMBER: 0001209191-12-017379 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120308 FILED AS OF DATE: 20120312 DATE AS OF CHANGE: 20120312 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MOLINA J MARIO MD CENTRAL INDEX KEY: 0001246792 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-31719 FILM NUMBER: 12682542 MAIL ADDRESS: STREET 1: C/O MOLINA HEALTHCARE, INC. STREET 2: ONE GOLDEN SHORE DRIVE CITY: LONG BEACH STATE: CA ZIP: 90802 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 X0304 4 2012-03-08 0 0001179929 MOLINA HEALTHCARE INC MOH 0001246792 MOLINA J MARIO MD 300 UNIVERSITY AVE., SUITE 100 SACRAMENTO CA 95825 1 1 0 1 President & CEO Settlor-Molina Siblings Trust Common Stock 2012-03-08 4 S 0 15200 33.0754 D 84594 D Common Stock 461132 D Common Stock 120869 I Trustee of trust Common Stock 43050 I Manager of limited liability company Common Stock 107309 I Trustee of trust Common Stock 43131 I Trust Common Stock 240000 I General partner of family partnership Common Stock 250000 I Trust Common Stock 1362 I Trust Common Stock 1362 I Trust Common Stock 1361 I Trust Common Stock 1361 I Trust Stock Option (Right to Buy) 20.88 2017-03-01 Common Stock 54000 54000 D Represents the weighted average sale price of all sales on the Transaction Date. The range of prices for the transactions was $33.00 to $33.21. The Reporting Person undertakes to provide full information about the transactions to the Commission upon request. The shares were issued pursuant to the Issuer's Equity Incentive Plan and are fully vested. An additional 11,700 vest on March 1, 2013 and 5,850 vest on March 1, 2014. The shares are owned by Dr. Molina and his spouse as community property. The shares are owned by the J. Marion Molina Separate Property Trust, of which Dr. Molina is sole trustee. The shares are owned by the Molina Family, LLC, of which Dr. Molina is the sole manager. The shares are owned by JMB GRAT 1209/4 for the benefit of Josephine M. Battiste, of which Dr. Molina is sole trustee. The shares are owned by JMM GRAT 1208/5, of which Dr. Molina is beneficiary. The shares are owned by the Molina Family Partnership, L.P., of which Dr. Molina is the sole general partner. Dr. Molina and his spouse each hold a 0.5% ownership interest in the partnership. The remaining 99% of ownership interests in the partnership are held in equal amounts by the Joseph Marion Molina, M.D. Annuity Trust No. 1, the Joseph Marion Molina, M.D. Annuity Trust No. 2 and the Joseph Marion Molina, M.D. Annuity Trust No. 3. Dr. Molina is trustee and certain immediate family members of Dr. Molina are the beneficiaries of these trusts. The shares are owned by JMM GRAT 911/4, of which Dr. Molina is the beneficiary. 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. 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. The shares are woned by Dr. Molina's spouse, Therese A. Molina, Trustee of the Remainder Trust for Carly F. Fox dated 12/3/2008. 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. The options are fully vested. /s/ Joseph M. Molina, M.D., by Karen Calhoun, Attorney-in-Fact 2012-03-12