0001209191-21-036572.txt : 20210528
0001209191-21-036572.hdr.sgml : 20210528
20210528165540
ACCESSION NUMBER: 0001209191-21-036572
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: Portocalis Gerasimos (Jerry)
CENTRAL INDEX KEY: 0001863390
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40429
FILM NUMBER: 21981286
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
0001863390
Portocalis Gerasimos (Jerry)
18390 NE 68TH ST.
REDMOND
WA
98052
0
1
0
0
Chief Commercial Officer
Common Stock
2021-05-28
4
J
0
810565
D
0
I
See Explanation of Responses
Class A Common Stock
2021-05-28
4
P
0
47619
21.00
A
47619
I
See Explanation of Responses
Stock Option (Right to Buy)
8.66
2021-05-28
4
J
0
50000
0.00
D
2029-08-27
Common Stock
50000
0
D
Stock Option (Right to Buy)
8.66
2021-05-28
4
J
0
50000
0.00
A
2029-08-27
Class B Common Stock
50000
50000
D
Stock Option (Right to Buy)
0.03
2021-05-28
4
J
0
323250
0.00
D
2023-02-20
Common Stock
323250
0
D
Stock Option (Right to Buy)
0.03
2021-05-28
4
J
0
323250
0.00
A
2023-02-20
Class B Common Stock
323250
323250
D
Class B Common Stock
2021-05-28
4
J
0
810565
0.00
A
Class A Common Stock
810565
810565
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 shares held directly by Faliron Investments LLC. 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.
Represents shares acquired pursuant to a directed share program in connection with the Issuer's initial public offering of Class A 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.
/s/ John Morrow, Attorney-in-Fact
2021-05-28