0001179929-17-000218.txt : 20171106
0001179929-17-000218.hdr.sgml : 20171106
20171106195916
ACCESSION NUMBER: 0001179929-17-000218
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20171106
FILED AS OF DATE: 20171106
DATE AS OF CHANGE: 20171106
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Zubretsky Joseph M
CENTRAL INDEX KEY: 0001320929
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-31719
FILM NUMBER: 171180833
MAIL ADDRESS:
STREET 1: C/O THE HANOVER INSURANCE GROUP, INC.
STREET 2: 440 LINCOLN STREET
CITY: WORCESTER
STATE: MA
ZIP: 01653
ISSUER:
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
BUSINESS ADDRESS:
STREET 1: 200 OCEANGATE, SUITE 100
CITY: LONG BEACH
STATE: CA
ZIP: 90802
BUSINESS PHONE: 5624353666
MAIL ADDRESS:
STREET 1: 200 OCEANGATE, SUITE 100
CITY: LONG BEACH
STATE: CA
ZIP: 90802
3
1
wf-form3_151001634285178.xml
FORM 3
X0206
3
2017-11-06
0
0001179929
MOLINA HEALTHCARE INC
MOH
0001320929
Zubretsky Joseph M
300 UNIVERSITY AVENUE
SUITE 100
SACRAMENTO
CA
95825
1
1
0
0
President & CEO
Stock Option (Right to Buy)
67.33
2027-10-08
Common Stock
375000.0
D
The options shall vest in one-third increments on each of October 9, 2018, October 9, 2019, and October 9, 2020.
Jeff D. Barlow, by power of attorney for Joseph M. Zubretsky
2017-11-06
EX-24
2
zubretskyjosephm-section16.txt
LIMITED POWER OF ATTORNEY
LIMITED POWER OF ATTORNEY FOR SECTION 16(a) FILINGS
Know all by these presents, that the undersigned hereby constitutes
and appoints Jeff D. Barlow and Codruta Boggs, and each acting
singly, the undersigned's true and lawful attorney-in-fact to:
1) execute for and on behalf of the undersigned, in the undersigned's
capacity as an officer, director and/or stockholder of Molina
Healthcare, Inc. (the "Company"), Forms 3, 4, and 5 and amendments
thereto in accordance with Section 16(a) of the Securities Exchange
Act of 1934 and the rules thereunder; and
2) do and perform any and all acts for and on behalf of the
undersigned which may be necessary or desirable to complete and
execute any such Form 3, 4, or 5 or amendment thereto
and timely file such form with the United States Securities and Exchange
Commission (the "SEC") and any stock exchange or similar authority.
The undersigned hereby grants to each such attorney-in-fact full power
and authority to do and perform any and every act and thing whatsoever
requisite, necessary, or proper to be done in the exercise of any of
the rights and powers herein granted, as fully to all intents and
purposes as the undersigned might or could do if personally present,
with full power of substitution or revocation, hereby ratifying and
confirming all that such attorney-in-fact, or such attorney-in-fact's
substitute or substitutes, shall lawfully do or cause to be done by
virtue of this Power of Attorney and the rights and powers herein granted.
The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not
assuming, nor is the Company assuming, any of the undersigned's
responsibilities to comply with Section 16 of the Securities Exchange
Act of 1934.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect
to the undersigned's holdings of and transaction in securities of the
Company, unless earlier revoked by the undersigned in a signed writing
delivered to the foregoing attorneys-in-fact. This Power of Attorney
may be filed with the SEC as a confirming statement of the authority
granted herein.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney
to be executed as of this 9th day of October, 2017.
/s/ Joseph M. Zubretsky
Signature
Joseph M. Zubretsky
Printed Name
MPK 64585-1.058517.0015