SEC Form 4
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*
DENTINO WILLIAM

(Last) (First) (Middle)
3500 DOUGLAS BLVD., SUITE 160

(Street)
ROSEVILLE CA 95661

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MOLINA HEALTHCARE INC [ MOH ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) X Other (specify below)
Trustee of trust owners
3. Date of Earliest Transaction (Month/Day/Year)
10/17/2017
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 10/17/2017 S(1) 22,500 D $61.0859(2) 3,405,050 I Trustee(3)
Common Stock 254,209 I Trustee(4)
Common Stock 16,099 I Executor(5)
Common Stock 208,795 I Trustee(6)
Common Stock 270,555 I Trustee(7)
Common Stock 295,750 I Trustee(8)
Common Stock 344,906 I Trustee(9)
Common Stock 172,990 I Trustee(10)
Common Stock 192,705 I Trustee(11)
Common Stock 206,719 I Trustee(12)
Common Stock 4,090,360 I Trustee(13)
Common Stock 300 D(14)
Common Stock 1,496 D(15)
Common Stock 154,291 I Trustee(16)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
1. Name and Address of Reporting Person*
DENTINO WILLIAM

(Last) (First) (Middle)
3500 DOUGLAS BLVD., SUITE 160

(Street)
ROSEVILLE CA 95661

(City) (State) (Zip)
1. Name and Address of Reporting Person*
PEDERSEN CURTIS

(Last) (First) (Middle)
6218 EAST 6TH STREET

(Street)
LONG BEACH CA 90803

(City) (State) (Zip)
1. Name and Address of Reporting Person*
MARY R MOLINA LIVING TRUST

(Last) (First) (Middle)
3500 DOUGLAS BLVD., SUITE 160

(Street)
ROSEVILLE CA 95661

(City) (State) (Zip)
1. Name and Address of Reporting Person*
MOLINA MARITAL TRUST

(Last) (First) (Middle)
3500 DOUGLAS BLVD., SUITE 160

(Street)
ROSEVILLE CA 95661

(City) (State) (Zip)
Explanation of Responses:
1. Sale pursuant to the Rule 10b5-1 Trading Plan of the Mary R Molina Living Trust.
2. Represents the weighted average sale price of all sales on the Transaction Date. The range of prices for the transactions was $60.31 to $62.14. The Reporting Person undertakes to provide full information about the transactions to the Commission upon request.
3. The shares are owned by the Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
4. The shares are owned by the MRM GRAT 812/3 of which Mr. Dentino and Mr. Pedersen are co-trustees.
5. The shares are owned by the Estate of Mary R. Molina, of which Mr. Dentino is executor.
6. The shares are owned by MRM GRAT 610/5, of which Mr. Dentino and Mr. Pedersen are co-trustees.
7. The shares are owned by the MRM GRAT 609/7, of which Mr. Dentino and Mr. Pedersen are co-trustees.
8. The shares are owned by MRM GRAT 1210/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
9. The shares are owned by MRM GRAT 811/3, of which Mr. Dentino and Mr. Pedersen are co-trustees.
10. The shares are owned by MRM GRAT 610/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
11. The shares are owned by the MRM GRAT 1209/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
12. The shares are owned by the MRM GRAT 609/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
13. The shares are owned by the Molina Marital Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
14. The shares are owned by Mr. Pedersen.
15. The shares are owned by Mr. Dentino.
16. The shares are owned by the MRM GRAT 1209/3, of which Mr. Dentino and Mr. Pedersen are co-trustees.
Remarks:
William Dentino, by Karen Calhoun, Attorney-In-Fact 10/18/2017
Curtis Pedersen, by Karen Calhoun, Attorney-In-Fact 10/18/2017
William Dentino and Curtis Pedersen, Co-Trustees of the Mary R Molina Living Trust, by Karen Calhoun, Attorney-In-Fact 10/18/2017
William Dentino and Curtis Pedersen, Co-Trustees of the Molina Marital Trust, by Karen Calhoun, Attorney-In-Fact 10/18/2017
** 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.
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