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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Put Equivalent Position | (4) | 08/20-04:00/2012 | J(3) | 52 (3) | (4) | (4) | Common Stock | 52 (3) | (3) (4) | 103 (4) | I | See footnotes (1) (2) (3) (4) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Jones Adrian M C/O GOLDMAN, SACHS & CO. 200 WEST STREET NEW YORK, NY 10282 |
Kevin P. Treanor, Attorney-in-fact | 08/23-04:00/2012 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The Reporting Person is a managing director of Goldman, Sachs & Co. ("Goldman Sachs"). Goldman Sachs is a wholly-owned subsidiary of The Goldman Sachs Group, Inc. ("GS Group"). The Reporting Person disclaims beneficial ownership of the securities reported herein except to the extent of his pecuniary interest therein, if any. |
(2) | The shares of common stock, par value $0.875 per share (the "Common Stock"), of Dollar General Corporation (the "Company") reported herein may be deemed to be beneficially owned directly by Goldman Sachs International ("GSI") and indirectly by GS Group. GSI is a wholly-owned subsidiary of GS Group. Without admitting any legal obligation, GSI or another wholly-owned subsidiary of GS Group will remit appropriate profits, if any, to the Company. |
(3) | Reflects the decrease in a short position in a basket of stocks that includes shares of Common Stock. The decrease has been calculated based on the notional number of shares of Common Stock included in the basket. GS Group disclaims any beneficial ownership of, or pecuniary interest in, the Common Stock included in the basket. |
(4) | After the decrease, a notional of 103 shares of Common Stock remain in the basket on which the put equivalent is based. The put equivalent is cash-settled and will terminate on June 6, 2013, however, optional early termination may be exercised by both counterparties. |