Statement of Changes in Beneficial Ownership (4)
August 11 2021 - 05:11PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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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 * Parson Matt |
2. Issuer Name and Ticker or Trading
Symbol Paymentus Holdings, Inc. [ PAY ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chief Financial Officer |
(Last)
(First)
(Middle)
18390 NE 68TH ST. |
3. Date of Earliest Transaction (MM/DD/YYYY)
8/9/2021
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(Street)
REDMOND, WA 98052
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line) _X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Class A Common Stock |
8/9/2021 |
|
A |
|
4165 (1) |
A |
$0.00 |
8926 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
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1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of derivative Securities Beneficially
Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of
Responses: |
(1) |
Represents restricted stock
units ("RSUs") granted pursuant to the 2021 Equity Incentive Plan.
One fourth (1/4th) of the RSUs shall vest on May 15, 2022, and one
sixteenth (1/16th) of the RSUs shall vest on a quarterly basis
thereafter on each subsequent, consecutive Quarterly Vesting Date.
Quarterly Vesting Dates with respect to any calendar year means
February 15, May 15, August 15 and November 15. Any Quarterly
Vesting Date that is scheduled to occur on a day that is not a
Trading Day, shall be deemed to occur on the next Trading
Day. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Parson Matt
18390 NE 68TH ST.
REDMOND, WA 98052 |
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|
Chief Financial Officer |
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Signatures
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/s/ John Morrow, Attorney-in-Fact |
|
8/11/2021 |
**Signature of Reporting
Person |
Date |
Paymentus (NYSE:PAY)
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From Jun 2022 to Jul 2022
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From Jul 2021 to Jul 2022