0001209191-17-043516.txt : 20170705 0001209191-17-043516.hdr.sgml : 20170705 20170705175948 ACCESSION NUMBER: 0001209191-17-043516 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170701 FILED AS OF DATE: 20170705 DATE AS OF CHANGE: 20170705 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 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: 17949452 MAIL ADDRESS: STREET 1: C/O MOLINA HEALTHCARE, INC. STREET 2: ONE GOLDEN SHORE DRIVE CITY: LONG BEACH STATE: CA ZIP: 90802 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-07-01 0 0001179929 MOLINA HEALTHCARE INC MOH 0001246792 MOLINA J MARIO MD 15302 CENTRAL AVENUE CHINO CA 91710 1 0 0 0 Common Stock 2017-07-01 4 A 0 795 69.18 A 173565 I Trust Common Stock 419184 I Trust Common Stock 122956 I Trust Common Stock 18920 I Trust Common Stock 18920 I Trust Common Stock 18920 I Trust Common Stock 19280 I Trust Common Stock 42126 I Trust Common Stock 42126 I Trust Common Stock 42124 I Trust Common Stock 28536 I Trust Common Stock 65282 I Trust Common Stock 83087 I Trust Common Stock 83087 I Trust Common Stock 200000 I Trust Grant of stock under the Issuer's 2011 Equity Incentive Plan, as amended, in connection with the Reporting Person's services as a Director. The aggregate dollar value of the annual equity award to each director in 2017-2018 shall be $220,000, with one quarter of that amount in stock, or $55,000, to be granted on the first day of each quarter based on the closing price of the Issuer's common stock on such day. Since the grant date of July 1, 2017 was a non-trading day, the number of shares was calculated based on the closing price of the Issuer's common stock on June 30, 2017, of $69.18. Thus, the grant this quarter for services as a Director is for 795 shares of the Issuer's common stock. Represents the closing price of the Issuer's common stock on June 30, 2017. The shares are held by the M/T Molina Family Trust, of which Dr. Molina and his spouse are trustees and beneficiaries. The shares are owned by the J. Marion Molina Separate Property Trust, of which Dr. Molina is sole trustee. The shares are owned by Dr. Molina's spouse, Therese A. Molina, as trustee of the MM GRAT 915/3. The shares are owned by Dr. Molina, as trustee of the David M.F. Molina Trust No. 2 dated 5/14/2003. The shares are owned by Dr. Molina, as trustee of the Mary Clare F. Molina Trust No. 2 dated 5/14/2003. The shares are owned by Dr. Molina, as trustee of the Colleen A.F. Fox Trust No. 2 dated 5/14/2003. The shares are owned by Dr. Molina, as trustee of the Carley A.F. Fox Trust No. 2 dated 5/14/2003. 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 owned by Dr. Molina's spouse, Therese A. Molina, Trustee of the Remainder Trust for Colleen A.F. Fox dated 12/3/2008. 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. 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 Dr. Molina, as trustee of the Katherine Rose Battiste Trust IV. The shares are owned by Dr. Molina, as trustee of the Julius Avery Battiste Trust IV. The shares are owned by JMM GRAT 716/3, of which Dr. Molina is the beneficiary. /s/ Joseph M. Molina, M.D., by Karen Calhoun, Attorney-in-Fact 2017-07-05