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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 Options (Right to Buy) | $ 25.33 | 02/10/2005(3) | 02/10/2014 | Common Stock | 15,000 | 15,000 | D | ||||||||
Stock Options (Right to Buy) | $ 44.29 | 07/01/2006(4) | 07/01/2015 | Common Stock | 5,000 | 5,000 | D | ||||||||
Stock Option (Right to Buy) | $ 28.66 | 02/02/2007(5) | 02/02/2016 | Common Stock | 15,000 | 15,000 | D | ||||||||
Stock Option (Right to Buy) | $ 31.32 | 03/01/2008(6) | 03/01/2017 | Common Stock | 3,000 | 3,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KOONTZ LILLIS ANN 2277 FAIR OAKS BLVD, STE 440 SACRAMENTO, CA 95825 |
VP, Health Plan Operations |
Lillis Ann Koontz, by Jeff D. Barlow, Attorney-in-Fact. | 07/02/2007 | |
**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. 2002 Employee Stock Purchase Plan. |
(2) | 8,334 of the shares vest in full on 9/13/2007. 3,500 shares vest in one-quarter increments on 3/1/08, 3/1/09, 3/1/10, and 3/1/11. 3,500 of the vested shares are subject to a restriction on transfer until August 2, 2007. The remainder of the shares are fully vested. |
(3) | The options vest in one-third increments on each of 2/10/2005, 2/10/2006, and 2/10/2007. |
(4) | The options vest in one-third increments on each of 7/1/2006, 7/1/2007, and 7/1/2008. |
(5) | The options vest in one-third increments on each of 2/2/2007, 2/2/2008, and 2/2/2009. |
(6) | The options vest in one-quarter increments on each of 3/1/08, 3/1/09, 3/1/10, and 3/1/11. |