Initial Statement of Beneficial Ownership (3)
April 23 2021 - 7:17PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Salaymeh Omar |
2. Date of Event Requiring Statement (MM/DD/YYYY)
4/19/2021
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3. Issuer Name and Ticker or Trading Symbol
GTY Technology Holdings Inc. [GTYH]
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(Last)
(First)
(Middle)
C/O GTY TECHNOLOGY HOLDINGS INC., 1180 NORTH TOWN CENTER DRIVE, SUITE 100 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) CEO of Bonfire / |
(Street)
LAS VEGAS, NV 89144
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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 | 97025 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 | (1) | (1) | Common Stock | 51372 | $2.4458 | D | |
Restricted Stock Units | (2) | (2) | Common Stock | 50639 | (2) | D | |
Explanation of Responses: |
(1) | The reporting person has been granted 51,372 stock options (the "Options"). Previously, 44,512 of the Options vested. Subject to the reporting person continuing to be employed with the issuer, an additional 1,712 of the Options vest each month. Each vested Option is exercisable at a price of $2.4458 for one share of the issuer's common stock. |
(2) | Each restricted stock unit represents a contingent right to receive one share of the issuer's common stock. If the reporting person remains employed with the issuer at such time, 26,562 restricted stock units will vest on February 19, 2022; 17,410 restricted stock units will vest on February 19, 2023; and 6,667 restricted stock units will vest on February 19, 2024. Restricted stock units may be settled in shares of the issuer's common stock or cash. |
Remarks: See Exhibit 24.1 - Power of Attorney. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Salaymeh Omar C/O GTY TECHNOLOGY HOLDINGS INC. 1180 NORTH TOWN CENTER DRIVE, SUITE 100 LAS VEGAS, NV 89144 |
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| CEO of Bonfire |
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Signatures
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/s/ Jon C. Bourne, Attorney-in-Fact | | 4/23/2021 |
**Signature of Reporting Person | Date |
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