SEC Form 4 · accession 0001209191-17-059618

MOLINA HEALTHCARE, INC. · MOH

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owners

Curtis Pedersen

10% Owner · Other

William Dentino

10% Owner · Other

Period of report

Nov 7, 2017

Accepted (ET)

Nov 7, 2017 · 4:50 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001179929

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	Nov 7, 2017	J	4,090,360	$0.00	D	0	I	Trustee
Common Stock^F3,F4	holding	—	—		—	3,376,792	I	Trustee
Common Stock^F5	holding	—	—		—	28,258	I	Trustee
Common Stock^F6	holding	—	—		—	254,209	I	Trustee
Common Stock^F7,F8	holding	—	—		—	47,273	I	Executor
Common Stock^F9	holding	—	—		—	208,795	I	Trustee
Common Stock^F10,F11	holding	—	—		—	239,381	I	Trustee
Common Stock^F12	holding	—	—		—	295,750	I	Trustee
Common Stock^F13	holding	—	—		—	344,906	I	Trustee
Common Stock^F14	holding	—	—		—	172,990	I	Trustee
Common Stock^F15	holding	—	—		—	192,705	I	Trustee
Common Stock^F16	holding	—	—		—	206,719	I	Trustee
Common Stock^F17	holding	—	—		—	300	I	Trustee
Common Stock^F18	holding	—	—		—	1,496	I	Trustee
Common Stock^F19	holding	—	—		—	154,291	I	Trustee

Table II — derivative securities

No Table II lines on this filing.

Explanation of responses

F1Distribution to beneficiaries without consideration.
F10Previously reported in error as 270,555 shares.
F11The shares are owned by the MRM GRAT 609/7, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F12The shares are owned by MRM GRAT 1210/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F13The shares are owned by MRM GRAT 811/3, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F14The shares are owned by MRM GRAT 610/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F15The shares are owned by the MRM GRAT 1209/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F16The shares are owned by the MRM GRAT 609/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F17The shares are owned by the Curtis and Rosi Pedersen 2012 Trust, of which Mr. Pedersen and his spouse are co-trustees.
F18The shares are owned by the Dentino Family Trust, of which Mr. Dentino is sole trustee.
F19The shares are owned by the MRM GRAT 1209/3, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F2The shares are owned by the Molina Marital Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F3Previously included in error the shares owned by the Exempt Mary R. Molina Living Trust.
F4The shares are owned by the Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F5The shares are owned by the Exempt Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
F6The shares are owned by the MRM GRAT 812/3 of which Mr. Dentino and Mr. Pedersen are co-trustees.
F7Previously reported in error as 16,099 shares.
F8The shares are owned by the Estate of Mary R. Molina, of which Mr. Dentino is executor.
F9The shares are owned by MRM GRAT 610/5, of which Mr. Dentino and Mr. Pedersen are co-trustees.

Remarks

See Exhibit 99 for the names, addresses and signatures of Additional Reporting Persons.