FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
1. Name and Address of Reporting Person*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 06/07/2024 |
3. Issuer Name and Ticker or Trading Symbol
Waystar Holding Corp. [ WAY ] |
|||||||||||||
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
5. If Amendment, Date of Original Filed
(Month/Day/Year) |
||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Beneficially Owned | |||
---|---|---|---|
1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 21,469 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
---|---|---|---|---|---|---|---|
1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Options (right to buy) | (1) | 09/17/2028 | Common Stock | 151,203 | $4.14 | D | |
Stock Options (right to buy) | (2) | 10/23/2029 | Common Stock | 408,375 | $16.53 | D | |
Stock Options (right to buy) | (3) | 08/09/2030 | Common Stock | 60,500 | $18.19 | D | |
Stock Options (right to buy) | (4) | 08/16/2032 | Common Stock | 15,125 | $33.06 | D | |
Stock Options (right to buy) | (5) | 05/01/2034 | Common Stock | 38,115 | $37.2 | D | |
Stock Options (right to buy) | (6) | 06/06/2034 | Common Stock | 380,434 | $21.5 | D |
Explanation of Responses: |
1. These options are currently vested. |
2. Options granted on October 23, 2019 of which 50% of the option vests in five substantially equal annual installments commencing on October 22, 2020 and the remaining 50% of the option vests upon achievement of certain specified performance-based vesting criteria. |
3. Options granted on August 9, 2020 of which 50% of the option vests in five substantially equal annual installments commencing on August 9, 2021 and the remaining 50% of the option vests upon achievement of certain specified performance-based vesting criteria. |
4. Options granted on August 16, 2022 of which 50% of the option vests in five substantially equal annual installments commencing on August 16, 2023 and the remaining 50% of the option vests upon achievement of certain specified performance-based vesting criteria. |
5. Options granted on May 1, 2024 which vest in three equal annual installments commencing on May 1, 2025 |
6. Options granted on June 6, 2024 which vest in five equal annual installments commencing on June 6, 2025. |
Remarks: |
Exhibit 24 - Power of Attorney. |
/s/ Matthew R. A. Heiman, as Attorney-in-Fact | 06/07/2024 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |