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, par value $0.001 per share | 7,223,290(1) | D(2)(3) |
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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Explanation of Responses: |
1. Prior to consummation of the Issuer's initial public offering of its common stock, par value $0.001 per share (the "Common Stock"), the Common Stock will undergo a 555-for-1 split. The amount of securities beneficially owned by the reporting persons reported on this Form 3 reflects the number of shares of Common Stock that the reporting persons will beneficially own upon consummation of the stock split. |
2. Green Equity Investors II, L.P. ("GEI") is the direct owner of 7,223,290 shares of Common Stock of the Issuer (the "Shares"). Grand Avenue Capital Partners, L.P. ("GACP") is the general partner of GEI. Grand Avenue Capital Corporation ("GACC") is the general partner of GACP. Leonard Green & Partners, L.P. ("LGP") is the management company of GEI. LGP Management, Inc. ("LGPM") is the general partner of LGP. |
3. Each of GACP, GACC, LGP and LGPM, directly (whether through ownership or position) or indirectly through one or more intermediaries, may be deemed for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, to be the indirect beneficial owners of the Shares owned by GEI and, therefore, a "ten percent holder" hereunder. Each of GACP, GACC, LGP and LGPM disclaims beneficial ownership of the Shares reported herein, except to the extent of their pecuniary interest therein, and this report shall not be deemed an admission that the reporting persons are the beneficial owners of such securities for purposes of Section 16 or for any other purposes. |
Remarks: |
Exhibit List: Exhibit 24 -- Power of Attorney |
/s/ Jonathan D. Sokoloff, as Vice President of Grand Avenue Capital Partners, L.P., General Partner of Green Equity Investors II, L.P. | 01/27/2005 | |
/s/ Jonathan D. Sokoloff, as Vice President of Grand Avenue Capital Corporation, General Partner of Grand Avenue Capital Partners, L.P. | 01/27/2005 | |
/s/ Jonathan D. Sokoloff, as Vice President of Grand Avenue Capital Corporation | 01/27/2005 | |
/s/ Jonathan D. Sokoloff, as Vice President of LGP Management, Inc., General Partner of Leonard Green & Partners, L.P. | 01/27/2005 | |
/s/ Jonathan D. Sokoloff, as Vice President of LGP Management, Inc. | 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. |