-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, HRw3zQpxHNnGGHDDmC9gyT/sSDQTnl+I8BD4BkLmgtsyf++ed/4YPIJe4UY05mBk Xbe6iJH02ro3T1ACrc+FZg== 0001193125-04-020068.txt : 20040212 0001193125-04-020068.hdr.sgml : 20040212 20040211190046 ACCESSION NUMBER: 0001193125-04-020068 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040212 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MOLINA HEALTHCARE INC CENTRAL INDEX KEY: 0001179929 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 134204626 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-79561 FILM NUMBER: 04587895 BUSINESS ADDRESS: STREET 1: ONE GOLDEN SHORE DRIVE CITY: LONG BEACH STATE: CA ZIP: 90802 BUSINESS PHONE: 5624353666 MAIL ADDRESS: STREET 1: ONE GOLDEN SHORE DRIVE CITY: LONG BEACH STATE: CA ZIP: 90802 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: MOLINA MARITAL TRUST CENTRAL INDEX KEY: 0001246946 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: WILLIAM DENTINO & CURTIS PEDERSON STREET 2: 555 CAPITOL MALL #1500 CITY: SACRAMENTO STATE: CA ZIP: 95814 MAIL ADDRESS: STREET 1: WILLIAM DENTINO & CURTIS PEDERSON STREET 2: 555 CAPITOL MALL #1500 CITY: SACRAMENTO STATE: CA ZIP: 95814 SC 13G 1 dsc13g.htm MOLINA HEALTHCARE -- SC13G -- MOLINA MARITAL TRUST MOLINA HEALTHCARE -- SC13G -- MOLINA MARITAL TRUST

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

 

SCHEDULE 13G

 

 

Under the Securities Exchange Act of 1934

(Amendment No.         )*

 

 

 

 

 

Molina Healthcare, Inc.

(Name of Issuer)

 

 

Common Stock, par value $0.001 per share

(Title of Class of Securities)

 

 

60855R 10 0

                                (CUSIP Number)                                

 

 

December 31, 2003

(Date of Event Which Requires Filing of this Statement)

 

 

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

 

¨ Rule 13d-1(b)

 

¨ Rule 13d-1(c)

 

x Rule 13d-1(d)

 

 

*   The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

 

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

SCHEDULE 13G

 

CUSIP No. 60855R 10 0

 

  1.  

Names of Reporting Person.

I.R.S. Identification No. of above persons (entities only).

 

            Molina Marital Trust

    
  2.  

Check the Appropriate Box if a Member of a Group*

(a)  ¨

(b)  ¨

    
  3.  

SEC Use Only

 

    
  4.  

Citizenship or Place of Organization

 

            United States

    

NUMBER OF

SHARES

BENEFICIALLY

OWNED BY

EACH

REPORTING

PERSON

WITH

  

  5.    Sole Voting Power

 

                3,464,716

  6.    Shared Voting Power

 

                None

  7.    Sole Dispositive Power

 

                3,464,716

  8.    Shared Dispositive Power

 

                None

  9.  

Aggregate Amount Beneficially Owned by Each Reporting Person

 

            3,464,716

    
10.  

Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares*

 

¨

    
11.  

Percent of Class Represented by Amount in Row (9)

 

            13.6%1

    
12.  

Type of Reporting Person*

 

            OO

    

 

*SEE INSTRUCTIONS

1 Represents percentage ownership of all of the common stock outstanding

Item 1.

  

(a)

   

Name of Issuer:

 

Molina Healthcare, Inc.

          
   

(b)

   

Address of Issuer’s Principal Executive Offices

 

One Golden Shore Drive

Long Beach, California 90802

          

Item 2.

  

(a)

   

Name of Person Filing:

 

Molina Marital Trust

          
   

(b)

   

Address of Principal Business Office or, if none, Residence:

 

c/o William Dentino and Curtis Pedersen

555 Capitol Mall Suite 1500

Sacramento, California 95814

          
   

(c)

   

Citizenship:

 

United States

          
   

(d)

   

Title of Class of Securities:

 

Common Stock, par value $0.001 per share

          
   

(e)

    CUSIP Number:    60855R 10 0          

Item 3.

   If this statement is filed pursuant to §§240.13d-1(b), or 240.13d-2(b) or (c), check whether the person filing is a:     
    (a)    ¨    Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o).
    (b)    ¨    Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c).
    (c)    ¨    Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c).
    (d)    ¨    Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8).
    (e)    ¨    An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E);
    (f)    ¨    An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);
    (g)    ¨    A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G);
    (h)    ¨    A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);
    (i)    ¨    A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3);

    (j)    ¨    Group, in accordance with §240.13d-1(b)(1)(ii)(J).
    If this statement is filed pursuant to 240.13d-1(c), check this box. ¨

 

Item 4.

    Ownership:          
     Amount beneficially owned: 3,464,716          
     Percent of class: 13.6% of all common stock outstanding          
     Number of shares as to which the person has:          
          (i)    Sole power to vote or to direct the vote: 3,464,716          
          (ii)    Shared power to vote or to direct the vote: none          
          (iii)    Sole power to dispose or to direct the disposition of: 3,464,716          
          (iv)    Shared power to dispose or to direct the disposition of: none          

Item 5.

   

Ownership of Five Percent or Less of a Class:

 

Not applicable

     

Item 6.

   

Ownership of More than Five Percent on Behalf of Another Person:

 

Not applicable

          

Item 7.

   

Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company or Control Person:

 

Not applicable

Item 8.

   

Identification and Classification of Members of the Group:

 

Not applicable

          

Item 9.

   

Notice of Dissolution of Group:

 

Not applicable

          

SIGNATURE

 

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

 

Dated : February 10, 2004

 

MOLINA MARITAL TRUST

/s/    WILLIAM DENTINO        
Name/Title: William Dentino, Co-Trustee
/s/    CURTIS PEDERSEN        
Name/Title: Curtis Pedersen, Co-Trustee

 

 

Attention:   

Intentional misstatements or omissions of fact constitute Federal criminal violations. (See 18 U.S.C. 1001)

 -----END PRIVACY-ENHANCED MESSAGE-----