SEC FORM 4/A SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
DENTINO WILLIAM

(Last) (First) (Middle)
3300 DOUGLAS BLVD., SUITE 430

(Street)
ROSEVILLE CA 95661

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MOLINA HEALTHCARE INC [ MOH ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
Trustee of trust owners
3. Date of Earliest Transaction (Month/Day/Year)
12/06/2011
4. If Amendment, Date of Original Filed (Month/Day/Year)
12/27/2011
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 12/06/2011 G(1) V 8,955 D $0.00(2) 3,659,339(3) D(4)
Common Stock 4,090,360 D(5)
Common Stock 300 D(6)
Common Stock 1,500 D(7)
Common Stock 2,774 I Trustee(8)
Common Stock 2,774 I Trustee(9)
Common Stock 412,062 I Trustee(10)
Common Stock 388,176 I Trustee(11)
Common Stock 232,909 I Trustee(12)
Common Stock 303,739 I Trustee(13)
Common Stock 398,561 I Trustee(14)
Common Stock 385,768 I Trustee(15)
Common Stock 402,749 I Trustee(16)
Common Stock 536,792 I Trustee(17)
Common Stock 750,000 I Trustee(18)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
DENTINO WILLIAM

(Last) (First) (Middle)
3300 DOUGLAS BLVD., SUITE 430

(Street)
ROSEVILLE CA 95661

(City) (State) (Zip)
1. Name and Address of Reporting Person*
PEDERSEN CURTIS

(Last) (First) (Middle)
6218 EAST 6TH STREET

(Street)
LONG BEACH CA 90803

(City) (State) (Zip)
1. Name and Address of Reporting Person*
MARY R MOLINA LIVING TRUST

(Last) (First) (Middle)
3300 DOUGLAS BLVD., SUITE 430

(Street)
ROSEVILLE CA 95661

(City) (State) (Zip)
1. Name and Address of Reporting Person*
MOLINA MARITAL TRUST

(Last) (First) (Middle)
3300 DOUGLAS BLVD., SUITE 430

(Street)
ROSEVILLE CA 95661

(City) (State) (Zip)
Explanation of Responses:
1. Gift to family members.
2. Price not applicable to a gift.
3. Includes 63,208 shares transferred from MRM GRAT 1210/4 in a non-reportable transaction and corrects the total number of shares held.
4. The shares are owned by the Mary R. Molina Living Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
5. The shares are owned by the Molina Marital Trust, of which Mr. Dentino and Mr. Pedersen are co-trustees.
6. The shares are owned by Mr. Pedersen.
7. The shares are owned by Mr. Dentino.
8. The shares are owned by the MRM GRAT 905/7A, of which Mr. Dentino and Mr. Pedersen are co-trustees.
9. The shares are owned by the MRM GRAT 905/7B, of which Mr. Dentino and Mr. Pedersen are co-trustees.
10. The shares are owned by the MRM GRAT 609/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
11. The shares are owned by the MRM GRAT 609/7, of which Mr. Dentino and Mr. Pedersen are co-trustees.
12. The shares are owned by the MRM GRAT 1209/3, of which Mr. Dentino and Mr. Pedersen are co-trustees.
13. The shares are owned by the MRM GRAT 1209/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
14. The shares are owned by MRM GRAT 610/2, of which Mr. Dentino and Mr. Pedersen are co-trustees.
15. The shares are owned by MRM GRAT 610/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
16. The shares are owned by MRM GRAT 610/5, of which Mr. Dentino and Mr. Pedersen are co-trustees.
17. The shares are owned by MRM GRAT 1210/4, of which Mr. Dentino and Mr. Pedersen are co-trustees.
18. The shares are owned by MRM GRAT 811/3, of which Mr. Dentino and Mr. Pedersen are co-trustees.
Remarks:
Amended to correct a five share understatement of shares held by the MRM Living Trust and to reflect unreportable transfers of all shares held by MRM GRATs 508/3, 1108/2, 1108/3, 609/2 and 1209/2 to trusts for the benefit of Mary R. Molina's children, of which the Reporting Persons are not trustees.
William Dentino, by Karen Calhoun, Attorney-In-Fact 03/05/2012
Curtis Pedersen, by Karen Calhoun, Attorney-In-Fact 03/05/2012
William Dentino and Curtis Pedersen, Co-Trustees of the Mary R Molina Living Trust, by Karen Calhoun, Attorney-In-Fact 03/05/2012
William Dentino and Curtis Pedersen, Co-Trustees of the Molina Marital Trust, by Karen Calhoun, Attorney-In-Fact 03/05/2012
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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