-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, E9sjxDubbiZ/ZiHpRYk4vgCp6LxVLHswoATFd1NQL/UI/od7WrMWtNpjelK4YRhI QuJfGMtQuILRvzA5OdNOlg== 0000904454-10-000539.txt : 20101214 0000904454-10-000539.hdr.sgml : 20101214 20101214170511 ACCESSION NUMBER: 0000904454-10-000539 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20101214 FILED AS OF DATE: 20101214 DATE AS OF CHANGE: 20101214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BALSON ANDREW CENTRAL INDEX KEY: 0001212449 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35004 FILM NUMBER: 101251224 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FLEETCOR TECHNOLOGIES INC CENTRAL INDEX KEY: 0001175454 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE BUSINESS ADDRESS: STREET 1: 655 ENGINEERING DRIVE STREET 2: SUITE 300 CITY: NORCROSS STATE: GA ZIP: 30092 BUSINESS PHONE: 800-877-9019 MAIL ADDRESS: STREET 1: 655 ENGINEERING DRIVE STREET 2: SUITE 300 CITY: NORCROSS STATE: GA ZIP: 30092 3 1 edgar.xml PRIMARY DOCUMENT X0203 3 2010-12-14 0 0001175454 FLEETCOR TECHNOLOGIES INC FLT 0001212449 BALSON ANDREW C/O BAIN CAPITAL INVESTORS, LLC 111 HUNTINGTON AVENUE BOSTON MA 02199 1 0 1 0 Series D-4 Convertible Preferred Stock Common Stock 5711539 I See footnotes Andrew B. Balson is a managing director of Bain Capital Investors, LLC ("BCI"). BCI is the sole general partner of Bain Capital Partners VIII, L.P., which is the sole general partner of Bain Capital Fund VIII, L.P., which is the sole member of Bain Capital Fund VIII, LLC ("BCF"). BCI is also the managing partner of BCIP Associates III, which is the sole manager of BCIP Associates III, LLC ("BCIP-A"). BCI is also the managing partner of BCIP Trust Associates III, which is the sole member of BCIP T Associates III, LLC ("BCIP-TA"). BCI is also the managing partner of BCIP Associates III-B, which is the sole manager of BCIP Associates III-B, LLC ("BCIP-AB"). BCI is also the managing partner of BCIP Trust Associates III-B, which is the sole manager of BCIP T Associates III-B, LLC ("BCIP-TAB"). BCI is also the managing partner of BCIP Associates-G ("BCIP-AG" and together with BCF, BCIP-A, BCIP-TA, BCIP-AB and BCIP-TAB, the "Bain Entities"). By virtue of the relationships described in the foregoing footnotes, Mr. Balson may be deemed to share voting and dispositive power with respect to all of the Issuer's securities held by the Bain Entities. Mr. Balson disclaims beneficial ownership of the Issuer's securities held by each of the Bain Entities except to the extent of his pecuniary interest therein. The Issuer's preferred stock reported herein is convertible at any time by the holder and has no expiration date, but is subject to mandatory conversion upon certain events. Each share of preferred stock reported herein is convertible into 2.5 shares of the Issuer's common stock (subject to certain adjustments) and will automatically convert into 2.5 shares of the Issuer's common stock upon the closing of the Issuer's initial public offering. /s/ Andrew Balson 2010-12-14 -----END PRIVACY-ENHANCED MESSAGE-----