Statement of Changes in Beneficial Ownership (4)
March 08 2017 - 5:31PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
*
MOLINA JOHN C
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2. Issuer Name
and
Ticker or Trading Symbol
MOLINA HEALTHCARE INC
[
MOH
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
CFO
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(Last)
(First)
(Middle)
300 UNIVERSITY AVE., SUITE 100
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3. Date of Earliest Transaction
(MM/DD/YYYY)
3/6/2017
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(Street)
SACRAMENTO, CA 95825
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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3/6/2017
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S
(1)
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20341
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D
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$49.1942
(2)
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622074
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I
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Trustee of Family Trust
(3)
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Common Stock
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3/7/2017
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F
(4)
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3444
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D
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$48.52
(5)
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102368
(6)
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D
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Common Stock
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3/7/2017
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F
(7)
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1722
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D
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$48.52
(5)
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99068
(8)
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D
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Common Stock
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3/7/2017
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F
(9)
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3444
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D
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$48.52
(5)
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92468
(6)
(10)
(11)
(12)
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D
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Common Stock
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600714
(13)
(14)
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D
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Common Stock
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11154
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D
(15)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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Sale pursuant to the Rule 10b5-1 Trading Plan of the John C. Molina Separate Property Trust.
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(
2)
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Represents the weighted average sale price of all sales on the Transaction Date. The range of prices for the transactions was $48.77 to $49.62. The Reporting Person undertakes to provide full information about the transactions to the Commission upon request.
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(
3)
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The shares are owned by the John C. Molina Separate Property Trust, of which Mr. Molina is the trustee and beneficiary.
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(
4)
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The shares were applied to the payment of withholding taxes arising in connection with the vesting of 6,600 shares on March 7, 2017, based upon the Company's 2016 STARS rating achievement.
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(
5)
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Represents the closing price of the Issuer's common stock on March 7, 2017.
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(
6)
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Excludes 3,156 shares net of tax withholding now shown as fully vested.
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(
7)
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The shares were applied to the payment of withholding taxes arising in connection with the vesting of 3,300 shares on March 7, 2017, upon the Company's achievement of a certain business development target (Board approved acquisition).
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(
8)
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Excludes 1,578 shares net of tax withholding now shown as fully vested.
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(
9)
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The shares were applied to the payment of withholding taxes arising in connection with the vesting of 6,600 shares on March 7, 2017.
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(
10)
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6,600 shares shall vest based on the Company's 2017 after tax profit margin; 6,600 shares shall vest based on the Company's 2018 after tax profit margin; 6,600 shares shall vest based upon the Company's 2017 STARS ratings; 13,200 shares shall vest upon the Company's achievement of certain business development targets; 6,600 shares shall vest on each of March 7, 2018, and March 7, 2019.
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(
11)
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20,041 shares shall vest in one-third increments over three years, on each of March 1, 2018, March 1, 2019, and March 1, 2020.
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(
12)
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4,034 shares vest based on the Company's 2017 annual premium revenue achievement; 4,034 shares vest based on the Company's 2017 net profit margin achievement; 4,034 shares vest based on pre-tax income in fiscal year 2017; 8,068 shares shall vest in one-half increments over two years, on each of April 1, 2017, and April 1, 2018. See 2015 Definitive Proxy Statement.
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(
13)
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All of these shares are fully vested.
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(
14)
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Includes 7,890 shares vested on March 7, 2017 net of shares withheld for payment of taxes.
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(
15)
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The shares are owned by Mr. Molina and his spouse as community property.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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MOLINA JOHN C
300 UNIVERSITY AVE., SUITE 100
SACRAMENTO, CA 95825
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X
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CFO
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Signatures
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John C. Molina, by Karen I. Calhoun, Attorney-in-Fact
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3/8/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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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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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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