SEC Form 4 · accession 0001209191-17-053347

FIRST DATA CORP · FDC

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

Reporting owner

Officer — See remarks

Period of report

Sep 15, 2017

Accepted (ET)

Sep 19, 2017 · 5:47 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 15, 2017	C	28,000	$0.00	A	652,861	D
Class A Common Stock^F2	Sep 15, 2017	S	28,000	$17.8504	D	624,861	D
Class A Common Stock^F3	holding	—	—		—	33,715	I	See footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Class B Common Stock^F4,F5	—	Sep 15, 2017	C	28,000	D	—	—	Class A Common Stock	28,000	216,106	D

F1Each share of Class A Common Stock was issued upon the conversion of one share of Class B Common Stock.
F2The price represents the weighted average purchase price for multiple transactions reported on this line. The prices of the transactions ranged from $17.85 to $17.86, inclusive. Upon request of the SEC staff, First Data Corporation (FDC), or a security holder of FDC, the reporting person will provide full information regarding the number of shares purchased at each separate price.
F3Held by The Christine Larsen 2016 Grantor Retained Annuity Trust.
F4Shares of Class B common stock are convertible into shares of 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 the issuer, automatically upon transfer, with certain exceptions, and upon certain other events.
F5Includes 37,173 shares of restricted Class B common stock.

Executive Vice President, Chief Operations Officer