- Initial Statement of Beneficial Ownership (3)
26 5월 2011 - 3:10AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Expires:
February 28, 2011
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
*
Palmer Robert
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/9/2011
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3. Issuer Name
and
Ticker or Trading Symbol
Universal Business Payment Solutions Acquisition Corp [UBPS]
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(Last)
(First)
(Middle)
C/O UBPS, RADNOR FINANCIAL CENTER, 150 NORTH RADNOR-CHESTER ROAD, STE F-200
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
RADNOR, PA 19087
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, par value $0.001 per share
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34500
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Warrants
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(1)
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(2)
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Common Stock
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200000
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$6.90
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D
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Explanation of Responses:
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(
1)
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The warrants will become exercisable on the later of (i) May 9, 2012 and (ii) the consummation of a business combination.
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(
2)
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The warrants will expire on the earlier of (i) five years from the date on which a business combination is completed, (ii)
the liquidation of the trust account if the Issuer has not completed a business combination within the required time periods
or (iii) earlier upon redemption.
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Remarks:
The Power of Attorney, executed by Robert Palmer authorizing each of Bipin C. Shah and Peter B. Davidson to sign and file
filings relating to the Issuer on Robert Palmer's behalf is attached hereto as Exhibit 24.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Palmer Robert
C/O UBPS, RADNOR FINANCIAL CENTER
150 NORTH RADNOR-CHESTER ROAD, STE F-200
RADNOR, PA 19087
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X
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Signatures
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/s/ Peter B. Davidson, Attorney-in-Fact
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5/25/2011
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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