SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Wiener Donald B

(Last) (First) (Middle)
333 TEXAS STREET, SUITE 2350

(Street)
SHREVEPORT LA 71101

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
GREEN DOT CORP [ GDOT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/13/2010
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 12/13/2010 C 68,171 A $0.00 68,171 D
Class A Common Stock 12/13/2010 S 68,171 D $58.56 0 D
Class A Common Stock 12/13/2010 C 7,904(1) A $0.00 7,904 I By Katherine Elisabeth Shifke Trust U/A dated 4/11/91
Class A Common Stock 12/13/2010 S 7,904(1) D $58.56 0 I By Katherine Elisabeth Shifke Trust U/A dated 4/11/91
Class A Common Stock 12/13/2010 C 7,904(1) A $0.00 7,904 I By David Jacques Shifke Trust U/A dated 12/4/91
Class A Common Stock 12/13/2010 S 7,904(1) D $58.56 0 I By David Jacques Shifke Trust U/A dated 12/4/91
Class A Common Stock 0 I By Sophia Grace Wiener Trust U/A dated 8/19/03
Class A Common Stock 0 I By Andrew Charles Spomer Trust U/A dated 11/12/93
Class A Common Stock 0 I By Daniel Baron Spomer Trust U/A dated 4/10/96
Class A Common Stock 0 I By Kathryn Ellen Wiener Trust U/A Dated 11/12/93
Class A Common Stock 0 I By John Baron Wiener Trust U/A Dated 12/11/98
Class A Common Stock 0 I By Thomas Max Wiener Trust U/A Dated 3/16/99
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock(2) $0.00 12/13/2010 C 68,171 (2) (2) Class A Common Stock(3) 68,171 $0.00 666,598 D
Class B Common Stock(2) $0.00 12/13/2010 C 7,904(1) (2) (2) Class A Common Stock(3) 7,904 $0.00 121,403(1) I By Katherine Elisabeth Shifke Trust U/A dated 4/11/91
Class B Common Stock(2) $0.00 12/13/2010 C 7,904(1) (2) (2) Class A Common Stock(3) 7,904 $0.00 121,403(1) I By David Jacques Shifke Trust U/A dated 12/4/91
Class B Common Stock(2) $0.00 (2) (2) Class A Common Stock 123,402 123,402(1) I By Sophia Grace Wiener Trust U/A dated 8/19/03
Class B Common Stock(2) $0.00 (2) (2) Class A Common Stock 73,852 73,852(1) I By Andrew Charles Spomer Trust U/A dated 11/12/93
Class B Common Stock(2) $0.00 (2) (2) Class A Common Stock 73,852 73,852(1) I By Daniel Baron Spomer Trust U/A dated 4/10/96
Class B Common Stock(2) $0.00 (2) (2) Class A Common Stock 56,168 56,168(1) I By Kathryn Ellen Wiener Trust U/A Dated 11/12/93
Class B Common Stock(2) $0.00 (2) (2) Class A Common Stock 56,168 56,168(1) I By John Baron Wiener Trust U/A Dated 12/11/98
Class B Common Stock(2) $0.00 (2) (2) Class A Common Stock 56,168 56,168(1) I By Thomas Max Wiener Trust U/A Dated 3/16/99
Explanation of Responses:
1. The reporting person is the trustee of the trust and disclaims beneficial ownership of these securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of all of the reported securities for purposes of Section 16 or for any other purposes.
2. 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 and has no expiration date.
3. The holder elected to convert the shares of Class B Common Stock into Class A Common Stock, which Class A Common Stock has no exercisable date or expiration date.
Remarks:
/s Lina Davidian as attorney-in-fact for Donald B. Wiener 12/14/2010
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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