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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 3500 DOUGLAS BLVD., SUITE 160 ROSEVILLE, CA 95661 |
X | Trustee of trust owners | ||
PEDERSEN CURTIS 6218 EAST 6TH STREET LONG BEACH, CA 90803 |
Trustee of trust owners | |||
MARY R MOLINA LIVING TRUST 3500 DOUGLAS BLVD., SUITE 160 ROSEVILLE, CA 95661 |
X | |||
MOLINA MARITAL TRUST 3500 DOUGLAS BLVD., SUITE 160 ROSEVILLE, CA 95661 |
X |
William Dentino, by Karen Calhoun, Attorney-In-Fact | 10/13/2017 | |
**Signature of Reporting Person | Date | |
Curtis Pedersen, by Karen Calhoun, Attorney-In-Fact | 10/13/2017 | |
**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 | 10/13/2017 | |
**Signature of Reporting Person | Date | |
William Dentino and Curtis Pedersen, Co-Trustees of the Molina Marital Trust, by Karen Calhoun, Attorney-In-Fact | 10/13/2017 | |
**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) | Sale pursuant to the Rule 10b5-1 Trading Plan of the Mary R Molina Living Trust. |
(2) | The shares are owned by the Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(3) | The shares are owned by the MRM GRAT 812/3 of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(4) | The shares are owned by the Estate of Mary R. Molina, of which Mr. Dentino is executor. |
(5) | The shares are owned by MRM GRAT 610/5, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(6) | The shares are owned by the MRM GRAT 609/7, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(7) | The shares are owned by MRM GRAT 1210/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(8) | The shares are owned by MRM GRAT 811/3, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(9) | The shares are owned by MRM GRAT 610/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(10) | The shares are owned by the MRM GRAT 1209/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(11) | The shares are owned by the MRM GRAT 609/4, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(12) | The shares are owned by the Molina Marital Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees. |
(13) | The shares are owned by Mr. Pedersen. |
(14) | The shares are owned by Mr. Dentino. |
(15) | The shares are owned by the MRM GRAT 1209/3, of which Mr. Dentino and Mr. Pedersen are co-trustees. |