0001209191-21-036561.txt : 20210528
0001209191-21-036561.hdr.sgml : 20210528
20210528164921
ACCESSION NUMBER: 0001209191-21-036561
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: Sharma Dushyant
CENTRAL INDEX KEY: 0001863304
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40429
FILM NUMBER: 21981170
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-05-28
0
0001841156
Paymentus Holdings, Inc.
PAY
0001863304
Sharma Dushyant
18390 NE 68TH ST.
REDMOND
WA
98052
1
1
1
0
Chairman, President and CEO
Common Stock
2021-05-28
4
J
0
17549795
D
0
I
See Explanation of Responses
Common Stock
2021-05-28
4
J
0
1152560
D
0
I
See Explanation of Responses
Common Stock
2021-05-28
4
J
0
157167
D
0
I
See Explanation of Responses
Common Stock
2021-05-28
4
J
0
157167
D
0
I
See Explanation of Responses
Common Stock
2021-05-28
4
J
0
157167
D
0
I
See Explanation of Responses
Common Stock
2021-05-28
4
J
0
157167
D
0
I
See Explanation of Responses
Stock Option (Right to Buy)
8.66
2021-05-28
4
J
0
3304870
0.00
D
2029-04-08
Common Stock
3304870
0
I
See Explanation of Responses
Stock Option (Right to Buy)
8.66
2021-05-28
4
J
0
3304870
0.00
A
2029-04-08
Class B Common Stock
3304870
3304870
I
See Explanation of Responses
Class B Common Stock
2021-05-28
4
J
0
17549795
0.00
A
Class A Common Stock
17549795
17549795
I
See Explanation of Responses
Class B Common Stock
2021-05-28
4
J
0
1152560
0.00
A
Class A Common Stock
1152560
1152560
I
See Explanation of Responses
Class B Common Stock
2021-05-28
4
J
0
157167
0.00
A
Class A Common Stock
157167
157167
I
See Explanation of Responses
Class B Common Stock
2021-05-28
4
J
0
157167
0.00
A
Class A Common Stock
157167
157167
I
See Explanation of Responses
Class B Common Stock
2021-05-28
4
J
0
157167
0.00
A
Class A Common Stock
157167
157167
I
See Explanation of Responses
Class B Common Stock
2021-05-28
4
J
0
157167
0.00
A
Class A Common Stock
157167
157167
I
See Explanation of Responses
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.
Represents securities held directly by Ashigrace LLC. Dushyant Sharma is the sole manager of Ashigrace LLC and has sole voting and dispositive power with respect to the securities held by Ashigrace LLC.
Represents shares held directly by The Ruma Sharma Family Trust dated December 3, 2018. Mr. Sharma serves as the trustee for The Ruma Sharma Family Trust dated December 3, 2018.
Represents shares held directly by The Sharma Family Trust A dated March 30, 2021 ("The Sharma Family Trust A"). Mr. Sharma's spouse serves as the trustee for The Sharma Family Trust A. Mr. Sharma disclaims beneficial ownership of the shares held by The Sharma Family Trust A.
Represents shares held directly by The Sharma Family Trust B dated March 30, 2021 ("The Sharma Family Trust B"). Mr. Sharma's spouse serves as the trustee for The Sharma Family Trust B. Mr. Sharma disclaims beneficial ownership of the shares held by The Sharma Family Trust B.
Represents shares held directly by The Sharma Family Trust C dated March 30, 2021 ("The Sharma Family Trust C"). Mr. Sharma's spouse serves as the trustee for The Sharma Family Trust C. Mr. Sharma disclaims beneficial ownership of the shares held by The Sharma Family Trust C.
Represents shares held directly by The Sharma Family Trust D dated March 30, 2021 ("The Sharma Family Trust D"). Mr. Sharma's spouse serves as the trustee for The Sharma Family Trust D. Mr. Sharma disclaims beneficial ownership of the shares held by The Sharma Family Trust D.
One fifth (1/5th) of the shares subject to the award shall vest one year after January 25, 2019, or the Vesting Commencement Date, and one sixtieth (1/60th) of the shares subject to the award shall vest each month thereafter on the same day of the month as the Vesting Commencement Date.
/s/ John Morrow, Attorney-in-Fact
2021-05-28