SEC Form 3
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 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/06/2023 |
3. Issuer Name and Ticker or Trading Symbol
Repay Holdings Corp [ RPAY ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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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) |
Class A Common Stock | 121,888(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 |
Explanation of Responses: |
1. Includes 107,950 unvested restricted shares of Class A common stock from previous grants as follows: (a) 579 unvested shares from an award of 2,315 restricted shares granted July 13, 2020, which are scheduled to vest in a final installment on July 13, 2024; (b) 3,010 unvested shares from an award of 6,020 restricted shares granted February 24, 2021, which are scheduled to vest in two remaining equal installments commencing February 24, 2024; (c) 11,208 unvested shares from an award of 14,943 restricted shares granted February 23, 2022, which are scheduled to vest in three remaining equal installments commencing February 23, 2024; (d) 36,057 unvested shares from an award of 48,076 restricted shares granted November 4, 2022, which are scheduled to vest in three remaining equal installments commencing November 4, 2024; and (e) 57,096 unvested restricted shares granted March 19, 2023, which are scheduled to vest in four equal installments commencing March 19, 2024. |
Remarks: |
Exhibit 24 - Power of Attorney |
/s/Tyler B. Dempsey, as Attorney-in-Fact | 11/13/2023 | |
** 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. |