| 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
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person
*
| 2828 NORTH HARWOOD STREET |
| 15TH FLOOR |
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year)
05/10/2016
|
3. Issuer Name
and
Ticker or Trading Symbol
MONEYGRAM INTERNATIONAL INC
[
MGI
]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| SVP Global Operations |
|
5. 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 Beneficially Owned |
|---|
| 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
|
22,298
(1)
|
D
|
|
|
Common Stock
|
15,946
(2)
|
D
|
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 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 |
| Explanation of Responses: |
|
|
| Remarks: |
| Exhibit List: Exhibit 24 - Power of Attorney |
|
/s/ Francis Aaron Henry, attorney-in-fact |
05/16/2016 |
|
** 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). |
| 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. |
Exhibit 24
POWER OF ATTORNEY
I, Kamila K. Chytil, do hereby appoint Francis Aaron Henry and Paul N.
Beck, as my true and lawful attorneys-in-fact (each an "Attorney-in-Fact" and,
collectively, the "Attorneys- in-Fact"), each, individually or jointly, with
full power of substitution and resubstitution, to have full power and authority
to act in my name, place and stead and on my behalf to:
1) execute and deliver for and on behalf of me, in my capacity as one or
more of an officer, director, or significant stockholder of MoneyGram
International, Inc. or any of its subsidiaries (collectively, the
"Company"), reports, schedules, or other filings with respect to the
reporting of ownership of or transactions in securities of the Company
required to be made under the Securities Exchange Act of 1934, as
amended (the "Exchange Act") or the Securities Act of 1933, as amended
(the "Securities Act"), and the rules thereunder, including without
limitation, Schedules 13D and 13G, Forms 3, 4 and 5 and Form 144 and
any amendments, corrections, supplements or other changes thereto;
2) do and perform any and all acts for and on behalf of me that such
Attorney-in- Fact (in his or her sole discretion) determines may be
necessary or desirable to complete and execute any such reports,
schedules or other filings and timely file same with the U.S.
Securities and Exchange Commission and any stock exchange or other
authority; and
3) take any other action of any type whatsoever in connection with the
foregoing which, in the sole opinion of such Attorney-in-Fact, may be
of benefit to, in the best interest of, or legally required by me, it
being understood that the documents executed by such Attorney-in-Fact
on behalf of me pursuant to this Power of Attorney shall be in such
form and shall contain such terms and conditions as such Attorney-in-
Fact may approve in his or her sole discretion.
I hereby ratify and confirm all that the Attorneys-in-Fact shall lawfully
do or cause to be done by virtue of this Power of Attorney and the rights and
powers herein granted. I acknowledge that the Attorneys-in-Fact, in serving in
such capacity at my request, are not assuming, nor is the Company assuming, (i)
any of my responsibilities to comply with the requirements of the Exchange Act
or the Securities Act or any liability for my failure to comply with such
requirements, or (ii) any obligation or liability I incur for profit
disgorgement under Section 16(b) of the Exchange Act. I further acknowledge
that this Power of Attorney does not relieve me from responsibility for
compliance with my obligations under the Exchange Act or the Securities Act.
This Power of Attorney shall remain in full force and effect until I am no
longer subject to Sections 13 and 16 of the Exchange Act and Rule 144 of the
Securities Act with respect to my holdings of and transactions in securities
issued by the Company, unless earlier revoked by me in a signed writing
delivered to the Attorneys-in-Fact.
IN WITNESS WHEREOF, I have executed this Power of Attorney as of May 10,
2016.
Signature: /s/ Kamila K. Chytil
-----------------------------------
Name: Kamila K. Chytil
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