0001209191-21-036582.txt : 20210528 0001209191-21-036582.hdr.sgml : 20210528 20210528170700 ACCESSION NUMBER: 0001209191-21-036582 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210528 FILED AS OF DATE: 20210528 DATE AS OF CHANGE: 20210528 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INGRAM WILLIAM CENTRAL INDEX KEY: 0001269473 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40429 FILM NUMBER: 21981481 MAIL ADDRESS: STREET 1: C/O LEAP WIRELESS INTERNATIONAL, INC. STREET 2: 5887 COPLEY DRIVE CITY: SAN DIEGO STATE: CA ZIP: 92111 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Paymentus Holdings, Inc. CENTRAL INDEX KEY: 0001841156 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 18390 NE 68TH ST. CITY: REDMOND STATE: WA ZIP: 98052 BUSINESS PHONE: (888) 440-4826 MAIL ADDRESS: STREET 1: 18390 NE 68TH ST. CITY: REDMOND STATE: WA ZIP: 98052 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-05-28 0 0001841156 Paymentus Holdings, Inc. PAY 0001269473 INGRAM WILLIAM 18390 NE 68TH ST. REDMOND WA 98052 1 0 0 0 Class A Common Stock 2021-05-28 4 P 0 47619 21.00 A 47619 D Stock Option (Right to Buy) 9.55 2021-05-28 4 J 0 26195 0.00 D 2031-03-09 Common Stock 26195 0 D Stock Option (Right to Buy) 9.55 2021-05-28 4 J 0 26195 0.00 A 2031-03-09 Class B Common Stock 26195 26195 D Represents shares acquired pursuant to a directed share program in connection with the Issuer's initial public offering of Class A Common Stock. Pursuant to a reclassification exempt under Rule 16b-7, each share of Common Stock was automatically reclassified into one share of Class B Common Stock immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock. Class B Common Stock is convertible at any time, at the holder's election and automatically in connection with certain transfers and upon certain other events, into an equal number of shares of Class A Common Stock and has no expiration date. One third (1/3rd) of the shares subject to the award shall vest one year after February 25, 2021, or the Vesting Commencement Date, and one twelfth (1/12th) of the shares subject to the award shall vest quarterly thereafter on the same day of the month as the Vesting Commencement Date. /s/ John Morrow, Attorney-in-Fact 2021-05-28