FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/27/2005 |
3. Issuer Name and Ticker or Trading Symbol
DOLLAR FINANCIAL CORP [ DLLR ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 1,193,504 | I | See Footnotes(1)(2)(3)(4) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. This statement is being filed by The Goldman Sachs Group, Inc. ("GS Group"), Goldman, Sachs & Co. ("Goldman Sachs"), GS Mezzanine Partners, L.P. ("GS Mezzanine"), GS Mezzanine Partners Offshore, L.P. ("GS Mezzanine Offshore"), Bridge Street Fund 1998, L.P. ("Bridge 1998"), Stone Street Fund 1998, L.P. ("Stone 1998" and, together with GS Mezzanine, GS Mezzanine Offshore, and Bridge 1998, the "Limited Partnerships"), GS Mezzanine Advisors, L.L.C ("GS Mezzanine GP") and Stone Street 1998, L.L.C. ("Stone 1998 GP" and, together with GS Group, Goldman Sachs, the Limited Partnerships and GS Mezzanine GP, the "Reporting Persons"). |
2. Prior to consummation of the Issuer's initial public offering of its common stock, the common stock will undergo a 555-for-1 split. The amount of securities beneficially owned by the Reporting Person reported on this Form 3 reflects the number of shares of common stock that the Reporting Person will beneficially own upon consummation of the stock split. |
3. GS Mezzanine beneficially owns directly and its general partner, GS Mezzanine GP, may be deemed to beneficially own indirectly 749,353 shares of Common Stock. GS Mezzanine Offshore beneficially owns directly and its general partner, GS Mezzanine GP, may be deemed to beneficially own indirectly 402,391 shares of Common Stock. Bridge 1998 beneficially owns directly and its general partner, Stone 1998 GP, may be deemed to beneficially own indirectly 9,682 shares of Common Stock. Stone 1998 beneficially owns directly and its general partner, Stone 1998 GP, may be deemed to beneficially own indirectly, 32,078 shares of Common Stock. Each of GS Mezzanine GP and Stone 1998 GP disclaims beneficial ownership of the securities reported herein except to the extent of its pecuniary interest in such securities. |
4. Goldman Sachs and GS Group may be deemed to beneficially own indirectly, in the aggregate, 1,193,504 shares of Dollar Financial Corp. (the "Company") common stock, par value $0.001 per share ("Common Stock") through the Limited Partnerships, of which affiliates of Goldman Sachs and GS Group are the general partner, managing general partner or managing partner. Goldman Sachs is the investment manager of certain of the Limited Partnerships. Goldman Sachs is a direct and indirect wholly-owned subsidiary of GS Group. Goldman Sachs and GS Group each disclaims beneficial ownership of the shares of Common Stock owned by the Limited Partnerships except to the extent of its pecuniary interest therein. |
/s/ Ted Chang, Attorney-in-fact | 01/27/2005 | |
/s/ Ted Chang, Attorney-in-fact | 01/27/2005 | |
/s/ Ted Chang, Attorney-in-fact | 01/27/2005 | |
/s/ Ted Chang, Attorney-in-fact | 01/27/2005 | |
/s/ Ted Chang, Attorney-in-fact | 01/27/2005 | |
/s/ Ted Chang, Attorney-in-fact | 01/27/2005 | |
/s/ Ted Chang, Attorney-in-fact | 01/27/2005 | |
/s/ Ted Chang, Attorney-in-fact | 01/27/2005 | |
** 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 5 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |