SEC Form 4 · accession 0001209191-17-067077

FIRST DATA CORP · FDC

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

Reporting owner

Officer — See remarks

Period of report

Dec 21, 2017

Accepted (ET)

Dec 22, 2017 · 4:33 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,F3	Dec 21, 2017	C	33,715	$0.00	A	33,715	I	See footnote
Class A Common Stock^F1	Dec 21, 2017	C	12,000	$0.00	A	636,861	D
Class A Common Stock	Dec 21, 2017	G	12,000	$0.00	D	624,861	D
Class A Common Stock^F5	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^F6,F7	—	Dec 21, 2017	C	33,715	D	—	—	Class A Common Stock	33,715	182,391	D
Class B Common Stock^F6,F7	—	Dec 21, 2017	C	12,000	D	—	—	Class A Common Stock	12,000	170,391	D

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 2017 Grantor Retained Annuity Trust on December 21, 2017.
F3Held by The Christine Larsen 2017 Grantor Retained Annuity Trust.
F4Represents a charitable donation of shares of Class A common stock by the reporting person.
F5Held by The Christine Larsen 2016 Grantor Retained Annuity Trust.
F6Shares 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.
F7Includes 37,173 shares of restricted Class B common stock.

Executive Vice President, Chief Operations Officer