Green Dot Corporation |
(Name of Issuer) |
Class A Common Stock, par value $0.001 per share |
(Title of Class of Securities) |
39304D 102 |
(CUSIP Number) |
December 31, 2011 |
(Date of Event Which Requires Filing of this Statement) |
CUSIP No. 39304D 102 | Page 2 of 5 Pages |
1 | NAME OF REPORTING PERSON Steven W. Streit | ||
2 | CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (See Instructions) (a) £ (b) £ | ||
3 | SEC USE ONLY | ||
4 | CITIZENSHIP OR PLACE OF ORGANIZATION U.S. | ||
NUMBER OF | 5 | SOLE VOTING POWER 4,234,143 shares (1)(2) | |
SHARES BENEFICIALLY OWNED | 6 | SHARED VOTING POWER 33,020 shares (2)(3) | |
BY EACH REPORTING | 7 | SOLE DISPOSITIVE POWER 4,234,143 shares (1)(2) | |
PERSON WITH | 8 | SHARED DISPOSITIVE POWER 33,020 shares (2)(3) | |
9 | AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 4,267,163 shares (1)(2)(3) | ||
10 | CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (See Instructions) £ | ||
11 | PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 12.4% * | ||
12 | TYPE OF REPORTING PERSON (See Instructions) IN |
(1) | Represents 2,642,294 shares held by the Steven W. Streit Family Trust DTD 9/30/2005, 400,000 shares held by the Streit 2009 GRAT A DTD 12/30/2009 and 20,000 shares held by the Streit 2009 GRAT B DTD 12/30/2009, for each of which trusts the Reporting Person is the trustee, 210,247 shares held by the Reporting Person and 961,602 shares subject to options held by the Reporting Person that are exercisable within 60 days of December 31, 2011. |
(2) | Represents Class B common stock of the Issuer. The Class B common stock is convertible at the holder's option into the Issuer's Class A common stock on a 1-for-1 basis. |
(3) | Represents 33,020 shares held by the Reporting Person's minor children. |
* | Based on 30,161,742 shares of Class A common stock outstanding as of December 31, 2011, as reported by the Issuer to the Reporting Person, plus the number of shares of Class B common stock held by the Reporting Person or affiliates of the Reporting Person, which are treated as outstanding only for the purpose of computing the percentage ownership of the Reporting Person. |
CUSIP No. 39304D 102 | Page 3 of 5 Pages |
Item 1. | |||
(a) | Name of Issuer: | ||
Green Dot Corporation (the "Issuer") | |||
(b) | Address of Issuer's Principal Executive Offices: | ||
605 East Huntington Drive, Suite 205 Monrovia, CA 91016 | |||
Item 2. | |||
(a) | Name of Person Filing: | ||
Steven W. Streit (the “Reporting Person”) | |||
(b) | Address of Principal Business Office: | ||
c/o Green Dot Corporation 605 East Huntington Drive, Suite 205 Monrovia, CA 91016 | |||
(c) | Citizenship: | ||
U.S. | |||
(d) | Title of Class of Securities: | ||
Class A Common Stock, par value $0.001 per share | |||
(e) | CUSIP Number: | ||
39304D 102 | |||
Item 3. | Not applicable | ||
Item 4. | Ownership | ||
The following information with respect to the ownership of the Class A Common Stock of the Issuer by the Reporting Person is provided as of December 31, 2011: | |||
(a) | Amount beneficially owned: | ||
See Row 9 of cover page for the Reporting Person | |||
(b) | Percent of class: | ||
See Row 11 of cover page for the Reporting Person |
CUSIP No. 39304D 102 | Page 4 of 5 Pages |
(c) | Number of shares as to which the person has: | ||
(i) | Sole power to vote or to direct the vote: | ||
See Row 5 of cover page for the Reporting Person | |||
(ii) | Shared power to vote or to direct the vote: | ||
See Row 6 of cover page for the Reporting Person | |||
(iii) | Sole power to dispose or to direct the disposition of: | ||
See Row 7 of cover page for the Reporting Person | |||
(iv) | Shared power to dispose or to direct the disposition of: | ||
See Row 8 of cover page for the Reporting Person | |||
Item 5. | Ownership of Five Percent or Less of a Class | ||
Not applicable | |||
Item 6. | Ownership of More than Five Percent on Behalf of Another Person | ||
Not applicable | |||
Item 7. | Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company | ||
Not applicable | |||
Item 8. | Identification and Classification of Members of the Group | ||
Not applicable | |||
Item 9. | Identification and Classification of Members of the Group | ||
Not applicable | |||
Item 10. | Certification | ||
Not applicable |
CUSIP No. 39304D 102 | Page 5 of 5 Pages |
Dated: | February 14, 2012 | /s/ Steven W. Streit | ||
Name: | Steven W. Streit |