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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) | 11/12/2016 | F(2) | 28,742 | (1)(3) | (1)(3) | Class A Common Stock | 28,742 | $ 14.6 | 151,248 | D | ||||
Stock Options (right to buy) | $ 12.65 | (4) | 11/12/2024 | Class B Common Stock (1) | 158,182 (5) | 158,182 (5) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Rosman Adam L. C/O FIRST DATA CORPORATION 225 LIBERTY STREET, 29TH FLOOR NEW YORK, NY 10281 |
See remarks |
/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) | 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. |
(2) | Represents shares withheld to pay tax obligations in connection with vesting of restricted stock. |
(3) | Includes 90,692 shares of restricted Class B common stock. |
(4) | These stock options vest in equal annual installments on each of the first five anniversaries of November 12, 2014, subject to continued employment through each applicable vesting date. |
(5) | This Form 4 corrects the Form 3 filed on October 15, 2015, which incorrectly reported the number of shares underlying the stock options as 158,162 instead of 158,182. The additional 20 shares are reflected in the number of shares reported in this Form 4. |
Remarks: Executive Vice President, General Counsel and Secretary |