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