SEC Form 4 · accession 0001209191-16-156900
FIRST DATA CORP · FDC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Christine E Larsen
Officer — See remarks
Period of report
Dec 23, 2016
Accepted (ET)
Dec 28, 2016 · 4:47 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 StockF1,F2,F3 | Dec 23, 2016 | C | 33,715 | $0.00 | A | 33,715 | I | See footnote |
| Class A Common Stock | holding | — | — | — | 441,071 | D |
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 StockF4,F5 | — | Dec 23, 2016 | C | 33,715 | D | — | — | Class A Common Stock | 33,715 | 287,355 | D |
Explanation of responses
- F1Each share of Class A Common Stock was issued upon the conversion of one share of Class B Common Stock.
- F2Reflects shares contributed to The Christine Larsen 2016 Grantor Retained Annuity Trust on December 23, 2016.
- F3Held by The Christine Larsen 2016 Grantor Retained Annuity Trust.
- 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.
- F5Includes 139,596 shares of restricted Class B common stock.
Remarks
Executive Vice President, Chief Operations Officer