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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 | ||||||||
Class B Common Stock | (4) | 09/30/2016 | C | 104,454 (2) | (4) | (4) | Class A Common Stock | 104,454 (2) | $ 0 | 151,596 (2) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
FOREHAND JOE W 18208 PRESTON ROAD SUITE D9-387 DALLAS, TX 75252 |
X |
/s/ Gretchen A. Herron, by power of attorney | 11/15/2016 | |
**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) | Each share of Class A Common Stock was issued upon the conversion of one share of Class B Common Stock. |
(2) | This Form 4 is being amended to report the correct number of shares converted and transferred and to correct the resulting balance of securities beneficially owned by Mr. Forehand following the transaction. |
(3) | Mr. Forehand transferred these shares to Firethorn Partners,Ltd., a limited partnership of which Mr. Forehand, his wife, children, and grandchildren are the sole limited partners and of which J.W. Forehand, LLC, a limited liability company controlled by Mr. Forehand, is the general partner. |
(4) | Shares of Class B common stock (Class B Common Stock) of First Data Corporation (FDC) are convertible into shares of Class A common stock of FDC (Class A Common Stock) on a one-for-one basis at any time at the option of the holder with the prior written consent of FDC, automatically upon transfer, with certain exceptions, and upon certain other events. |