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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 | ||||||||
Stock Option (Right to Buy) | $ 29.5267 (7) | (8) | 07/01/2015 | Common Stock | 4,500 | 6,750 (9) | D | ||||||||
Stock Option (Right to Buy) | $ 19.1067 (7) | (8) | 02/02/2016 | Common Stock | 9,500 | 14,250 (9) | D | ||||||||
Stock Option (Right to Buy) | $ 20.88 (7) | (8) | 03/01/2017 | Common Stock | 3,000 | 4,500 (9) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
WHITE JOSEPH W CPA 300 UNIVERSITY AVENUE, SUITE 100 SACRAMENTO, CA 95825 |
VP, Accounting |
Jeff D. Barlow, by power of attorney for Joseph W. White. | 01/04/2012 | |
**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) | The reporting person's failure to file his Form 4 report at the time of the scheduled purchase under the Molina Healthcare, Inc. 2011 Employee Stock Purchase Plan (the "ESPP") was inadvertent. |
(2) | The shares were acquired under the ESPP. |
(3) | Represents the closing price of issuer's common stock on June 30, 2011. The purchase price is based on the stock's lower market price as of the two following dates: (1) January 1, 2011, the first day of the ESPP offering period, and (2) June 30, 2011, the last day of the ESPP offering period. |
(4) | Amount of securities beneficially owned adjusted to reflect a 3:2 stock split effective May 20, 2011. |
(5) | 12,900 shares vest on 3/1/12; 11,500 shares vest on 3/1/13; 9,000 shares vest on 3/1/14; and 6,250 shares vest on 3/1/15. The remainder of the shares are vested. |
(6) | Represents the closing price of issuer's common stock on December 30, 2011. The purchase price is based on the stock's lower market price as of the two following dates: (1) July 1, 2011, the first day of the ESPP offering period, and (2) December 31, 2011, the last day of the ESPP offering period. |
(7) | Conversion or exercise price of derivative security adjusted to reflect a 3:2 stock split effective May 20, 2011. |
(8) | The options are fully vested. |
(9) | Number of derivative securities beneficially owned adjusted to reflect a 3:2 stock split effective May 20, 2011. |