0001209191-15-043457.txt : 20150515 0001209191-15-043457.hdr.sgml : 20150515 20150515183335 ACCESSION NUMBER: 0001209191-15-043457 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20150507 FILED AS OF DATE: 20150515 DATE AS OF CHANGE: 20150515 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: GREEN DOT CORP CENTRAL INDEX KEY: 0001386278 STANDARD INDUSTRIAL CLASSIFICATION: FINANCE SERVICES [6199] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3465 E. FOOTHILL BLVD CITY: PASADENA STATE: CA ZIP: 91107 BUSINESS PHONE: 6267652000 MAIL ADDRESS: STREET 1: 3465 E. FOOTHILL BLVD CITY: PASADENA STATE: CA ZIP: 91107 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shifke Mark L CENTRAL INDEX KEY: 0001497742 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34819 FILM NUMBER: 15871338 MAIL ADDRESS: STREET 1: 605 E. HUNTINGTON DRIVE, SUITE 205 CITY: MONROVIA STATE: CA ZIP: 91016 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2015-05-07 0 0001386278 GREEN DOT CORP GDOT 0001497742 Shifke Mark L 3465 EAST FOOTHILL BOULEVARD PASADENA CA 91107 0 1 0 0 Acting Chief Financial Officer Class A Common Stock 680327 D Class A Common Stock 121903 I By daughter Stock Option (right to buy Class A Common Stock) 12.75 2022-10-01 Class A Common Stock 19380 D Stock Option (right to buy Class A Common Stock) 18.56 2020-05-08 Class A Common Stock 37500 D Represents (a) 528,144 shares of Class A common stock held directly, and (b) 152,183 shares underlying restricted stock unit awards that will vest on various dates between July 5, 2015 and January 2, 2019, subject to the reporting person's provision of services to the issuer on each vesting date. Options vest as to 1/4 of the shares on August 3, 2013 and then 1/48th monthly thereafter, subject to the reporting person's provision of services to the issuer on each vesting date. Options vest as to 1/4 of the shares on May 8, 2014 and then 1/48th monthly thereafter, subject to the reporting person's provision of services to the issuer on each vesting date. /s/ Lina Davidian as attorney-in-fact for Mark L. Shifke 2015-05-15 EX-24.3_582937 2 poa.txt POA DOCUMENT GREEN DOT CORPORATION SECTION 16 REPORTS POWER OF ATTORNEY The undersigned hereby constitutes and appoints Kristina Lockwood and Lina Davidian, as long as they are serving as employees of Green Dot Corporation (the "Company"), or either of them, the undersigned's true and lawful attorney-in-fact to: (1) execute for and on behalf of the undersigned, in the undersigned's capacity as an officer, director and/or stockholder of the Company, Forms 3, 4 and 5 and amendments thereto in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended, and the rules and regulations thereunder; (2) do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to complete and execute any such Form 3, 4 or 5 or amendment thereto and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and (3) take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-fact's discretion. The undersigned hereby grants to such attorney-in-fact full power and authority to do and perform each and every act and thing whatsoever requisite, necessary or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution and revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorney-in-fact, in serving in such capacity at the request of the undersigned, is not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended. The undersigned agrees that such attorney-in-fact may rely entirely on information furnished orally or in writing by the undersigned to such attorney-in-fact. The undersigned also agrees to indemnify and hold harmless the Company and such attorney-in-fact against any losses, claims, damages or liabilities (or actions in these respects) that arise out of or are based on any untrue statement or omission of necessary facts in the information provided by the undersigned to such attorney-in-fact for purposes of executing, acknowledging, delivering and filing Forms 3, 4 or 5 (including amendments thereto) and agrees to reimburse the Company and such attorney-in-fact for any legal or other expenses reasonably incurred in connection with investigating or defending against any such loss, claim, damage, liability or action. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorney-in-fact. This Power of Attorney may be filed with the SEC as a confirming statement of the authority granted herein. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 28th day of July, 2010. /s/ Mark L. Shifke Name: Mark L. Shifke