0001209191-21-035767.txt : 20210525
0001209191-21-035767.hdr.sgml : 20210525
20210525185018
ACCESSION NUMBER: 0001209191-21-035767
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20210525
FILED AS OF DATE: 20210525
DATE AS OF CHANGE: 20210525
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Portocalis Gerasimos (Jerry)
CENTRAL INDEX KEY: 0001863390
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40429
FILM NUMBER: 21962209
MAIL ADDRESS:
STREET 1: 18390 NE 68TH ST.
CITY: REDMOND
STATE: WA
ZIP: 98052
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2021-05-25
0
0001841156
Paymentus Holdings, Inc.
PAY
0001863390
Portocalis Gerasimos (Jerry)
18390 NE 68TH ST.
REDMOND
WA
98052
0
1
0
0
Chief Commercial Officer
Common Stock
810565
I
See Explanation of Responses
Stock Option (Right to Buy)
8.66
2029-08-27
Common Stock
50000
D
Stock Option (Right to Buy)
0.03
2023-02-20
Common Stock
323250
D
Immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock, each share of Common Stock shall be reclassified into one share of Class B 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.
Gerasimos (Jerry) Portocalis is the President of Faliron Investments LLC and has sole voting and investment power with respect to the shares held by Faliron Investments LLC, which directly holds 810,565 shares of Common Stock.
One sixtieth (1/60th) of the shares subject to the award shall vest on September 30, 2019, and one sixtieth (1/60th) of the shares subject to the award shall vest on the last day of each month thereafter.
The shares subject to the option are fully vested and exercisable.
Exhibit 24 - Power of Attorney
/s/ John Morrow, Attorney-in-Fact
2021-05-25
EX-24.3_988178
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
The undersigned, as a Section 16 reporting person of Paymentus Holdings, Inc.
(the "Company"), hereby constitutes and appoints Barbara Mery, Nabiila
Hendryani-Soehedi, each of the responsible attorneys and paralegals of Wilson
Sonsini Goodrich & Rosati, Professional Corporation, and John Morrow, Matt
Parson, Kelly Weisweaver and Maria Goffman of the Company, the undersigned's
true and lawful attorney-in-fact to:
1. complete and execute Forms ID, 3, 4 and 5 and other forms and all
amendments thereto as such attorney-in-fact shall in his or her discretion
determine to be required or advisable pursuant to Section 16 of the Securities
Exchange Act of 1934 (as amended) and the rules and regulations promulgated
thereunder, or any successor laws and regulations, as a consequence of the
undersigned's ownership, acquisition or disposition of securities of the
Company; and
2. do all acts necessary in order to file such forms with the Securities
and Exchange Commission, any securities exchange or national association, the
Company and such other person or agency as the attorney-in-fact shall deem
appropriate.
The undersigned hereby ratifies and confirms all that said
attorneys-in-fact and agents shall do or cause to be done by virtue hereof. The
undersigned acknowledges that the foregoing attorneys-in-fact, in serving in
such capacity at the request of the undersigned, are not assuming, nor is the
Company assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934 (as amended).
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms ID, 3, 4 and 5 with respect to
the undersigned's holdings of and transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing delivered
to the Company and the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of May 12, 2021
/s/ Gerasimos (Jerry) Portocalis
_________________________________
Signature
Gerasimos (Jerry) Portocalis
_________________________________
Print Name