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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 |
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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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Holdings LP Interests | (1) | 10/16/2017 | M(1) | 2,078,337 | (4) | (4) | Class A Common Stock | 2,078,337 | $ 0 | 24,465,706 | I | By FSC CT II, Inc. (2) | |||
Holdings LP Interests | (4) | (4) | (4) | Class A Common Stock | 2,597,640 | 2,597,640 | D | ||||||||
Holdings LP Interests | (4) | (4) | (4) | Class A Common Stock | 3,048,092 | 3,048,092 | I | By Tannenbaum Family 2012 Trust (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
TANNENBAUM LEONARD M C/O FIFTH STREET (FSAM) 777 WEST PUTNAM AVENUE, 3RD FLOOR GREENWICH, CT 06830 |
X | X | CEO |
/s/ Leonard M. Tannenbaum | 10/18/2017 | |
**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) | On October 16, 2017, FSC CT II, Inc., pursuant to the Exchange Agreement (as defined below), exchanged limited partnership interests ("Holdings LP Interests") of Fifth Street Holdings L.P. ("Holdings") for shares of the Issuer's Class A common stock on a one-for-one basis. Pursuant to the Exchange Agreement, upon an exchange of the Holdings LP Interests for Class A common stock, Mr. Tannenbaum submitted to the Issuer a corresponding amount of Class B common stock for cancellation. |
(2) | Represents securities held directly by FSC CT II, Inc., a Delaware corporation. Mr. Tannenbaum disclaims beneficial ownership except to the extent of his economic interest therein. |
(3) | Represents securities held directly by the Tannenbaum Family 2012 Trust. Mr. Tannenbaum disclaims beneficial ownership except to the extent of his economic interest therein. |
(4) | Mr. Tannenbaum is permitted to exchange the remaining Holdings LP Interests in accordance with the terms of the exchange agreement, dated as of October 29, 2014, by and among the Issuer, Holdings and the limited partners of Holdings party thereto (the "Exchange Agreement"), subject to the requirements of the Cutback Agreement, dated as of September 26, 2017, among the Issuer, Holdings and the limited partners of Holdings party thereto. |