UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series D-3 Convertible Preferred Stock | 06/29/2005 | Â (2) | Common Stock | 8,634,619 (3) | $ (2) | I | Manager of GP of 10% owner. |
Series E Convertible Preferred Stock | 03/30/2009 | Â (4) | Common Stock | 4,283,332 (5) | $ (4) | I | Manager of GP of 10% owner. |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SUMMIT PARTNERS L P 222 BERKELEY STREET 18TH FLOOR BOSTON, MA 02116 |
 |  |  | Manager of GP of 10% owner. |
SUMMIT PARTNERS VI GP LLC C/O SUMMIT PARTNERS, LP 222 BERKLEY STREET, 18TH FLOOR BOSTON, MA 02116 |
 |  |  | Manager of GP of 10% owner. |
SUMMIT PARTNERS VI GP LP C/O SUMMIT PARTNERS, LP 222 BERKLEY STREET, 18TH FLOOR BOSTON, MA 02116 |
 |  |  | Manager of GP of 10% owner. |
STAMPS WOODSUM & CO IV C/O SUMMIT PARTNERS, LP 222 BERKLEY STREET, 18TH FLOOR BOSTON, MA 02116 |
 |  |  | Manager of GP of 10% owner. |
SUMMIT PARTNERS SD II LLC C/O SUMMIT PARTNERS, L.P. 222 BERKLEY STREET, 18TH FLOOR BOSTON, MA 02116 |
 |  |  | Manager of GP of 10% owner. |
Summit Partners PE VII, LLC C/O SUMMIT PARTNERS, L.P. 222 BERKELEY STREET, 18TH FLOOR BOSTON, MA 02110 |
 |  |  | Manager of GP of 10% owner. |
Summit Partners PE VII, L.P. C/O SUMMIT PARTNERS, L.P. 222 BERKELEY STREET, 18TH FLOOR BOSTON, MA 02110 |
 |  |  | Manager of GP of 10% owner. |
Summit Investors Management, LLC C/O SUMMIT PARTNERS, L.P. 222 BERKELEY STREET, 18TH FLOOR BOSTON, MA 02110 |
 |  |  | Manager of GP of 10% owner. |
MANNION MARTIN J C/O SUMMIT PARTNERS, L.P. 222 BERKELEY STREET, 18TH FLOOR BOSTON, MA 02116 |
 |  |  | Manager of GP of 10% owner. |
Summit Partners VI (GP), LLC, By /s/ Robin W. Devereux, as Attorney-in-Fact | 12/14/2010 | |
**Signature of Reporting Person | Date | |
Summit Partners VI (GP), L.P., By /s/ Robin W. Devereux, as Attorney-in-Fact | 12/14/2010 | |
**Signature of Reporting Person | Date | |
Stamps, Woodsum & Co. IV, By /s/ Robin W. Devereux, as Attorney-in-Fact | 12/14/2010 | |
**Signature of Reporting Person | Date | |
Summit Partners SD II, LLC, By /s/ Robin W. Devereux, as Attorney-in-Fact | 12/14/2010 | |
**Signature of Reporting Person | Date | |
Summit Partners PE VII, LLC, By /s/ Robin W. Devereux, as Attorney-in-Fact | 12/14/2010 | |
**Signature of Reporting Person | Date | |
Summit Partners PE VII, L.P., By /s/ Robin W. Devereux, as Attorney-in-Fact | 12/14/2010 | |
**Signature of Reporting Person | Date | |
Summit Investors Management, LLC, By /s/ Robin W. Devereux, as Attorney-in-Fact | 12/14/2010 | |
**Signature of Reporting Person | Date | |
By /s/ Robin W. Devereux, as Attorney-in-Fact for Martin Mannion | 12/14/2010 | |
**Signature of Reporting Person | Date | |
Summit Partners, L.P., By /s/ Robin W. Devereux, as Attorney-in-Fact | 12/14/2010 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Shares are held as follows: 10,655,742 in the name of Summit Ventures VI-A, L.P., 221,610 in the name of Summit VI Advisors Fund, L.P., 340,245 in the name of Summit VI Entrepreneurs Fund, L.P., 4,443,870 in the name of Summit Ventures VI-B, L.P., 89,845 in the name of Summit Investors VI, L.P., and 364,135 in the name of Summit Subordinated Debt Fund II, L.P. |
(2) | The Series D-3 Convertible Preferred Stock is convertible into Fleetcor Technologies, Inc. common stock on a two and one-half-for-one basis and has no expiration date. |
(3) | The shares underlying the Series D-3 Convertible Preferred Stock are held as follows: 5,842,167 in the name of Summit Ventures VI-A, L.P., 121,500 in the name of Summit VI Advisors Fund, L.P., 186,545 in the name of Summit VI Entrepreneurs Fund, L.P., 2,436,417 in the name of Summit Ventures VI-B, L.P., and 47,990 in the name of Summit Investors VI, L.P. |
(4) | The Series E Convertible Preferred Stock is convertible into Fleetcor Technologies, Inc. common stock on a two and one-half-for-one basis and has no expiration date. |
(5) | The shares underlying the Series E Convertible Preferred Stock are held as follows: 305 in the name of Summit Investors VI, L.P., 63,020 in the name of Summit Subordinated Debt Fund II, L.P., 2,626,060 in the name of Summit Partners Private Equity Fund VII-A, L.P., 1,577,252 in the name of Summit Partners Private Equity Fund VII-B, L.P., 15,110 in the name of Summit Investors I, LLC and 1,585 in the name of Summit Investors I (UK), L.P. |
 Remarks: The entities mentioned in Footnotes 1, 3 and 5 are collectively referred to as the "Summit Entities."  Summit Partners, L.P. is (i) the managing member of Summit Partners VI (GP), LLC, which is the general partner of Summit Partners VI (GP), L.P., which is the general partner of each of Summit Ventures VI-A, L.P., Summit Ventures VI-B, L.P., Summit VI Advisors Fund, L.P., Summit VI Entrepreneurs Fund, L.P. and Summit Investors VI, L.P.; (ii) the managing member of Stamps, Woodsum & Co. IV, which is the managing member of Summit Partners SD II, LLC, which is the general partner of Summit Subordinated Debt Fund II, L.P.; (iii) the managing member of Summit Partners PE VII, LLC, which is the general partner of Summit Partners PE VII, L.P., which is the general partner of Summit Partners Private Equity Fund VII-A, L.P. and Summit Partners Private Equity Fund VII-B, L.P., and (iv) the manager of Summit Investors Management, LLC, which is manager of Summit Investors I, LLC and the general partner of Summit Investors I (UK), L.P.  Summit Partners, L.P., through a two-person investment committee currently composed of Martin J. Mannion and Bruce R. Evans, has voting and dispositive authority over the shares held by the Summit Entities, and therefore may beneficially own such shares.  Mr. Mannion, as a member of the two person investment committee, may beneficially own such shares.  Each of the Summit Entities and Mr. Mannion disclaim beneficial ownership of shares, and this report shall not be deemed an admission that the Reporting Persons are the beneficial owners of the shares for the purpose of Section 16 or for any other purpose, except, in each case, to the extent of each such Reporting Person's pecuniary interest therein. Exhibits: Exhibit 24 - Power of Attorney |