SEC Form 4/A · accession 0001209191-16-150283

FIRST DATA CORP · FDC

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

This is an amendment (Form 4/A). It replaces an earlier filing for the same period.

Reporting owner

Director

Period of report

Sep 30, 2016

Accepted (ET)

Nov 15, 2016 · 5:54 pm EST

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,F2	Sep 30, 2016	C	104,454	$0.00	A	114,438	D
Class A Common Stock^F2	Sep 30, 2016	G	104,454	$0.00	D	9,984	D
Class A Common Stock^F2	Sep 30, 2016	G	104,454	$0.00	A	104,454	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^F2,F4	—	Sep 30, 2016	C	104,454	D	—	—	Class A Common Stock	104,454	151,596	D

F1Each share of Class A Common Stock was issued upon the conversion of one share of Class B Common Stock.
F2This 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.
F3Mr. 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.
F4Shares 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.