SEC Form 4 · accession 0001209191-16-143625

FIRST DATA CORP · FDC

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).

Reporting owner

Director

Period of report

Sep 30, 2016

Accepted (ET)

Oct 3, 2016 · 4:32 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000883980

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Class A Common Stock^F1	Sep 30, 2016	C	105,454	$0.00	A	115,438	D
Class A Common Stock	Sep 30, 2016	G	105,454	$0.00	D	9,984	D
Class A Common Stock	Sep 30, 2016	G	105,454	$0.00	A	105,454	I	By Firethorn Partners,Ltd.

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Class B Common Stock^F3	—	Sep 30, 2016	C	105,454	D	—	—	Class A Common Stock	105,454	150,596	D

F1Each share of Class A Common Stock was issued upon the conversion of one share of Class B Common Stock.
F2Mr. 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.
F3Shares 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.