0001562180-22-003613.txt : 20220502
0001562180-22-003613.hdr.sgml : 20220502
20220502182351
ACCESSION NUMBER: 0001562180-22-003613
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20210405
FILED AS OF DATE: 20220502
DATE AS OF CHANGE: 20220502
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Solomon Dan Alexandru
CENTRAL INDEX KEY: 0001772928
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38856
FILM NUMBER: 22883710
MAIL ADDRESS:
STREET 1: C/O PAGERDUTY, INC.
STREET 2: 600 TOWNSEND ST., STE. 200
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: PagerDuty, Inc.
CENTRAL INDEX KEY: 0001568100
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 272793871
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0131
BUSINESS ADDRESS:
STREET 1: 600 TOWNSEND STREET #200
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
BUSINESS PHONE: (844) 800-3889
MAIL ADDRESS:
STREET 1: 600 TOWNSEND STREET #200
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
4
1
primarydocument.xml
PRIMARY DOCUMENT
X0306
4
2021-04-05
false
0001568100
PagerDuty, Inc.
PD
0001772928
Solomon Dan Alexandru
600 TOWNSEND STREET, SUITE 200
SAN FRANCISCO
CA
94103
true
true
false
false
Co-Founder & GM Mindstorm
Common Stock
2021-04-05
4
G
false
274004.00
0.00
D
0.00
I
By Alex Solomon, as Trustee of the A. Solomon GRAT dated April 3, 2019
Common Stock
2021-04-05
4
G
false
115866.00
0.00
A
2790902.00
D
Reflects 274,004 shares transferred from the Alex Solomon, as Trustee of the A. Solomon GRAT dated April 3, 2019, to beneficiaries on April 5, 2021. A total of a) 115,866 shares were transferred from the Grantor Retained Annuity Trust to the Reporting Person; and b) 158,138 shares were transferred from the Grantor Retained Annuity Trust to a trust of which the Reporting Person is not a trustee or beneficiary.
Reflects 115,866 shares transferred from the Alex Solomon, as Trustee of the A. Solomon GRAT dated April 3, 2019 to the Reporting Person on April 5, 2021.
A portion of these shares represent restricted stock units.
Due to the late reporting of this transaction due to an administrative oversight, the Form 4s filed on the Reporting Person's behalf on October 5, 2021 and April 5, 2022 incorrectly reported the shares beneficially owned. After giving effect to this transaction, on October 5, 2021, the Reporting Person directly held 2,724,351 shares and indirectly held 0 shares. As of the Form 4 filed on the Reporting Person's behalf on April 5, 2022, the Reporting Person directly held 2,790,902 shares.
/s /Irving Gomez, Attorney-in-Fact for Dan Alexandru Solomon
2022-05-02
EX-24
2
asolomonpoa.txt
POWER OF ATTORNEY
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned hereby makes,
constitutes and appoints Stacey A. Giamalis, Irving Gomez, Howard
Wilson and Calise Cheng as the undersigned's true and lawful
attorney-in-fact, with full power and authority as hereinafter
described on behalf of and in the name, place and stead of the
undersigned to:
(1) prepare, execute, acknowledge, deliver and file Forms
3, 4, and 5 (including any amendments thereto) with respect
to the securities of PagerDuty, Inc., a Delaware corporation
(the "Company"), with the SEC, any national securities
exchanges and the Company, as considered necessary or
advisable under Section 16(a) of the Exchange Act and the
rules and regulations promulgated thereunder, as amended
from time to time;
(2) seek or obtain, as the undersigned's representative and
on the undersigned's behalf, information on transactions in
the Company's securities from any third party, including
brokers, employee benefit plan administrators and trustees,
and the undersigned hereby authorizes any such person to
release any such information to the undersigned and approves
and ratifies any such release of information; and
(3) perform any and all other acts which in the discretion
of such attorney-in-fact are necessary or desirable for and
on behalf of the undersigned in connection with the
foregoing.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes, but does not
require, such attorney-in-fact to act in their discretion on
information provided to such attorney-in-fact without
independent verification of such information;
(2) any documents prepared and/or executed by such
attorney-in-fact on behalf of the undersigned pursuant to
this Power of Attorney will be in such form and will contain
such information and disclosure as such attorney-in-fact, in
his or her discretion, deems necessary or desirable;
(3) neither the Company nor such attorney-in-fact assumes
(i) any liability for the undersigned's responsibility to
comply with the requirement of the Exchange Act, (ii) any
liability of the undersigned for any failure to comply with
such requirements, or (iii) any obligation or liability of
the undersigned for profit disgorgement under Section 16(b)
of the Exchange Act; and
(4) this Power of Attorney does not relieve the undersigned
from responsibility for compliance with the undersigned's
obligations under the Exchange Act, including without
limitation the reporting requirements under Section 16 of
the Exchange Act.
The undersigned hereby gives and grants the foregoing attorney-
in-fact full power and authority to do and perform all and every
act and thing whatsoever requisite, necessary or appropriate to
be done in and about the foregoing matters as fully to all
intents and purposes as the undersigned might or could do if
present, hereby ratifying all that such attorney-in-fact of, for
and on behalf of the undersigned, shall lawfully do or cause to
be done by virtue of this Limited Power of Attorney.
This Power of Attorney shall remain in full force and
effect until revoked by the undersigned in a signed writing
delivered to such attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this
Power of Attorney to be executed as of this 10th day of March
2022.
/s/ Alex Solomon
____________________________________
Alex Solomon