SEC Form 4 · accession 0001209191-16-150289
FIRST DATA CORP · FDC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Adam L. Rosman
Officer — See remarks
Period of report
Nov 12, 2016
Accepted (ET)
Nov 15, 2016 · 6:04 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000883980
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class B Common StockF1,F3 | — | Nov 12, 2016 | F | 28,742 | D | — | — | Class A Common Stock | 28,742 | 151,248 | D |
| Stock Options (right to buy)F5,F4,F1 | $12.65 | holding | — | — | — | — | Nov 12, 2024 | Class B Common Stock | 158,182 | 158,182 | D |
Explanation of responses
- F1Shares 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.
- F2Represents shares withheld to pay tax obligations in connection with vesting of restricted stock.
- F3Includes 90,692 shares of restricted Class B common stock.
- F4These 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.
- F5This 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