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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 | (1) | 04/11/2016 | F(2) | 196,249 (3) | (1)(4) | (1)(4) | Class A Common Stock | 196,249 (3) | $ 12.13 | 341,570 (3) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Larsen Christine E C/O FIRST DATA CORPORATION 225 LIBERTY STREET, 29TH FLOOR NEW YORK, NY 10281 |
See Remarks |
/s/ Gretchen A. Herron, by power of attorney | 08/03/2016 | |
**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) | Shares of Class B common stock of First Data Corporation (the "Issuer") are convertible into shares of Class A common stock of the Issuer on a one-for-one basis at any time at the option of the holder with the prior written consent of the Issuer, automatically upon transfer, with certain exceptions, and upon certain other events. |
(2) | Represents shares withheld to pay tax obligations in connection with the vesting of restricted stock awards. |
(3) | This Form 4 is being amended to report the correct number of shares withheld to pay tax obligations in connection with the vesting of restricted stock awards and to correct the resulting balance of securities beneficially owned by the Reporting Person following the transaction. |
(4) | Includes 139,596 shares of restricted Class B common stock of the Issuer, including 65,250 of which will vest on January 1, 2017 and 74,346 of which will vest in two equal installments on January 1, 2017 and January 1, 2018, subject to continued employment through the applicable vesting dates. Ms. Larsen's Form 3 filing had incorrectly reported 379,637 shares of restricted Class B common stock of the Issuer scheduled to vest on June 3, 2016 rather than on the date of the expiration of the 180-day lock-up period in connection with the Issuer's initial public offering (April 11, 2016). |
Remarks: Title - Executive Vice President, Chief Operations Officer |