Amended Statement of Changes in Beneficial Ownership (4/a)
August 03 2016 - 4:27PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
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0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Larsen Christine E
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2. Issuer Name
and
Ticker or Trading Symbol
FIRST DATA CORP
[
FDC
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
See Remarks
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(Last)
(First)
(Middle)
C/O FIRST DATA CORPORATION, 225 LIBERTY STREET, 29TH FLOOR
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3. Date of Earliest Transaction
(MM/DD/YYYY)
4/11/2016
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(Street)
NEW YORK, NY 10281
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
4/13/2016
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Class B Common Stock
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(1)
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4/11/2016
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F
(2)
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196249
(3)
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(1)
(4)
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(1)
(4)
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Class A Common Stock
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196249
(3)
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$12.13
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341570
(3)
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D
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Explanation of Responses:
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(
1)
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Shares of Class B common stock of First Data Corporation (the "Issuer") are convertible into shares of Class A common stock of the Issuer 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.
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(
2)
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Represents shares withheld to pay tax obligations in connection with the vesting of restricted stock awards.
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(
3)
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This Form 4 is being amended to report the correct number of shares withheld to pay tax obligations in connection with the vesting of restricted stock awards and to correct the resulting balance of securities beneficially owned by the Reporting Person following the transaction.
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(
4)
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Includes 139,596 shares of restricted Class B common stock of the Issuer, including 65,250 of which will vest on January 1, 2017 and 74,346 of which will vest in two equal installments on January 1, 2017 and January 1, 2018, subject to continued employment through the applicable vesting dates. Ms. Larsen's Form 3 filing had incorrectly reported 379,637 shares of restricted Class B common stock of the Issuer scheduled to vest on June 3, 2016 rather than on the date of the expiration of the 180-day lock-up period in connection with the Issuer's initial public offering (April 11, 2016).
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Remarks:
Title - Executive Vice President, Chief Operations Officer
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Larsen Christine E
C/O FIRST DATA CORPORATION
225 LIBERTY STREET, 29TH FLOOR
NEW YORK, NY 10281
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See Remarks
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Signatures
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/s/ Gretchen A. Herron, by power of attorney
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8/3/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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