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