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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DENTINO WILLIAM 3300 DOUGLAS BLVD., SUITE 430 ROSEVILLE, CA 95661 |
Trustee of trust owners | |||
PEDERSEN CURTIS 6218 EAST 6TH STREET LONG BEACH, CA 90803 |
Trustee of trust owners | |||
MARY R MOLINA LIVING TRUST 3300 DOUGLAS BLVD., SUITE 430 ROSEVILLE, CA 95661 |
X | |||
MOLINA MARITAL TRUST 3300 DOUGLAS BLVD., SUITE 430 ROSEVILLE, CA 95661 |
X |
William Dentino, by Karen Calhoun, Attorney-In-Fact | 12/27/2011 | |
**Signature of Reporting Person | Date | |
Curtis Pedersen, by Karen Calhoun, Attorney-In-Fact | 12/27/2011 | |
**Signature of Reporting Person | Date | |
William Dentino and Curtis Pedersen, Co-Trustees of the Mary R Molina Living Trust, by Karen Calhoun, Attorney-In-Fact | 12/27/2011 | |
**Signature of Reporting Person | Date | |
William Dentino and Curtis Pedersen, Co-Trustees of the Molina Marital Trust, by Karen Calhoun, Attorney-In-Fact | 12/27/2011 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Gift to family members. |
(2) | Price not applicable to a gift. |
(3) | Includes an aggregate of 1,851,015 shares previously transferred from MRM GRAT 308/3, MRM GRAT 507/4, MRM GRAT 508/3, MRM GRAT 609/2, MRM GRAT 609/4, MRM GRAT 609/7, MRM GRAT 610/2, MRM 610/4, MRM GRAT 610/5, MRM GRAT 905/7A, MRM GRAT 905/7B, MRM GRAT 1108/3, MRM GRAT 1209/2, MRM GRAT 1209/3 and MRM GRAT 1209/4 in non-reportable transactions. Excludes an aggregate of 750,000 shares previously transferred to MRM GRAT 811/3 in a non-reportable transaction. |
(4) | Amount of securities beneficially owned adjusted to reflect the 3:2 stock split effective May 20, 2011. |
(5) | The shares are owned by the Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(6) | The shares are owned by the Molina Marital Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(7) | The shares are owned by Mr. Pedersen. |
(8) | Excludes 185,167 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(9) | The shares are owned by the MRM GRAT 508/3, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(10) | The shares are owned by Mr. Dentino. |
(11) | Excludes 110,179 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(12) | The shares are owned by the MRM GRAT 905/7A, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(13) | The shares are owned by the MRM GRAT 905/7B, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(14) | The shares are owned by the MRM GRAT 1108/2, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(15) | Excludes 108,138 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(16) | The shares are owned by the MRM GRAT 1108/3, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(17) | Excludes 202,564 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(18) | The shares are owned by the MRM GRAT 609/2, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(19) | Excludes 85,737 shares previsouly transferred to the Mary R. Molina Living TRust in a non-reportable transaction. |
(20) | The shares are owned by the MRM GRAT 609/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(21) | Excludes 28,204 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(22) | The shares are owned by the MRM GRAT 609/7, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(23) | Excludes 173,837 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(24) | The shares are owned by the MRM GRAT 1209/2, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(25) | Excludes 106,964 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(26) | The shares are owned by the MRM GRAT 1209/3, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(27) | Excludes 70,169 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(28) | The shares are owned by the MRM GRAT 1209/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(29) | Excludes 201,439 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(30) | The shares are owned by MRM GRAT 610/2, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(31) | Excludes 64,232 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(32) | The shares are owned by MRM GRAT 610/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(33) | Excludes 47,251 shares previously transferred to the Mary R. Molina Living Trust in a non-reportable transaction. |
(34) | The shares are owned by MRM GRAT 610/5, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(35) | The shares are owned by MRM GRAT 1210/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(36) | Includes shares previously transferred from the Mary R. Molina Living Trust in a non-reportable transaction. |
(37) | The shares are owned by MRM GRAT 811/3, of which Mr. Dentino and Mr. Pedersen are co-trustees. |