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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 | |
WHITE JOSEPH W CPA 300 UNIVERSITY AVENUE, SUITE 100 SACRAMENTO, CA 95825 |
Chief Financial Officer | Interim President and CEO |
Jeff D. Barlow, by power of attorney for Joseph W. White | 01/02/2018 | |
**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 shares were acquired under the Molina Healthcare, Inc. 2011 Employee Stock Purchase Plan. |
(2) | Represents the closing price of the Issuer's common stock on June 30, 2017. The purchase price is based on the stock's lower market price as of the two following dates: (1) July 1, 2017, the first day of the ESPP offering period, and (2) December 31, 2017, the last day of the ESPP offering period. |
(3) | The shares vest as follows: (i) 15,008 shares shall vest in one-third increments over three years, on each of June 5, 2018, June 5, 2019, and June 5, 2020; (ii) 13,847 shares shall vest in one-third increments over three years, on each of March 1, 2018, March 1, 2019, and March 1, 2020; (iii) 4,317 shares shall vest based on the Company's 2017 after tax profit margin; (iv) 4,317 shares shall vest based on the Company's 2018 after tax profit margin; (v) 4,317 shares shall vest based upon the Company's 2017 STARS ratings; (vi) 6,476 shares shall vest upon the Company's achievement of certain business development targets; (vii) 8,636 shares shall vest one half on each of March 7, 2018 and March 7, 2019; continued |
(4) | (viii) 2,262 shares shall vest based on the Company's 2017 annual premium revenue achievement; (ix) 2,262 shares shall vest based on the Company's 2017 net profit margin achievement; (x) 2,262 shares shall vest based on pre-tax income in fiscal year 2017; (xi) 2,262 shares shall vest upon the Company's achieving a three-year Total Stockholder Return (TSR) for the three-year period ending December 31, 2017 as determined by ISS calculations that is greater than the median TSR achieved by the Company's 2015 ISS peer group; and (xii) 2,262 shares shall vest on April 1, 2018; the remainder of the shares are vested. |