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