|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
|
| ||||||||||||||||||||||||||||||||||||||
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series B Participating Convertible Preferred Stock | $ 2.5 | 05/18/2011 | M | 482,274.016 | (5) | (3) | Common Stock | 279,074,306 | (4) | 0 | I | See Note (1) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
THOMAS H. LEE ADVISORS, LLC 100 FEDERAL STREET, 35TH FLOOR BOSTON, MA 02110 |
X | X | ||
THL Equity Advisors VI, LLC 100 FEDERAL STREET, 35TH FLOOR BOSTON, MA 02110 |
X | X | ||
Thomas H. Lee Equity Fund VI, L.P. 100 FEDERAL STREET, 35TH FLOOR BOSTON, MA 02110 |
X | X | ||
Thomas H. Lee Parallel Fund VI, L.P. 100 FEDERAL STREET, 35TH FLOOR BOSTON, MA 02110 |
X | X |
THOMAS H. LEE ADVISORS, LLC, /s/ Charles Holden, Managing Director | 05/20/2011 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | See Exhibit 99.1 for text of footnote (1) |
(2) | See Exhibit 99.1 for text of footnote (2) |
(3) | See Exhibit 99.1 for text of footnote (3) |
(4) | See Exhibit 99.1 for text of footnote (4) |
(5) | See Exhibit 99.1 for text of footnote (5) |
Remarks: Exhibits 99.1 (Footnotes to Form 4) and 99.2 (Joint Filer Information) are incorporated herein by reference. This statement is being filed by Thomas H. Lee Advisors, LLC ("Advisors"), THL Equity Advisors VI, LLC ("Advisors VI"), Thomas H. Lee Equity Fund VI, L.P. ("Equity") and Thomas H. Lee Parallel Fund VI, L.P. ("Parallel"). Advisors is the general partner of Thomas H. Lee Partners, L.P., THL Coinvestment Partners, L.P. and THL Operating Partners, L.P. Thomas H. Lee Partners, L.P. is the manager of Advisors VI, which, in turn, is the general partner of Equity, Parallel, Thomas H. Lee Equity Parallel (DT) Fund VI, L.P. and THL Equity Fund VI Investors (MoneyGram), LLC. Pursuant to the Issuer's Amended and Restated Certificate of Incorporation, as amended, and that certain Amended and Restated Purchase Agreement, dated March 17, 2008, between the Issuer and the Investors party thereto, the reporting persons have rights to designate representatives to the Board of Directors of the Issuer. As of the date of this statement, Thomas Hagerty, Seth Lawry, Scott Jaeckel and Ganesh Rao serve on the Board of Directors of the Issuer as representatives of the reporting persons. |