0000904454-15-000743.txt : 20151118 0000904454-15-000743.hdr.sgml : 20151118 20151118170202 ACCESSION NUMBER: 0000904454-15-000743 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151118 FILED AS OF DATE: 20151118 DATE AS OF CHANGE: 20151118 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Paycom Software, Inc. CENTRAL INDEX KEY: 0001590955 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 800957485 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 7501 W. MEMORIAL ROAD CITY: OKLAHOMA CITY STATE: OK ZIP: 73142 BUSINESS PHONE: (405) 722-6900 MAIL ADDRESS: STREET 1: 7501 W. MEMORIAL ROAD CITY: OKLAHOMA CITY STATE: OK ZIP: 73142 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Donovan Michael CENTRAL INDEX KEY: 0001317659 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36393 FILM NUMBER: 151241417 MAIL ADDRESS: STREET 1: 320 PARK AVENUE, SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022-6815 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Welsh, Carson, Anderson & Stowe X, L.P. CENTRAL INDEX KEY: 0001328568 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36393 FILM NUMBER: 151241418 BUSINESS ADDRESS: STREET 1: 320 PARK AVENUE, SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: (212)893-9500 MAIL ADDRESS: STREET 1: 320 PARK AVENUE, SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ecock Anthony F CENTRAL INDEX KEY: 0001434789 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36393 FILM NUMBER: 151241415 MAIL ADDRESS: STREET 1: C/O ICAD INC STREET 2: 98 SPIT BROOK ROAD SUITE 100 CITY: NASHUA STATE: NH ZIP: 03062 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: REGAN BRIAN THOMAS CENTRAL INDEX KEY: 0001556077 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36393 FILM NUMBER: 151241416 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STREET 2: SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Solomon Christopher CENTRAL INDEX KEY: 0001608207 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36393 FILM NUMBER: 151241414 MAIL ADDRESS: STREET 1: C/O WELSH CARSON ANDERSON & STOWE STREET 2: 320 PARK AVENUE, SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2015-11-18 0001590955 Paycom Software, Inc. PAYC 0001328568 Welsh, Carson, Anderson & Stowe X, L.P. C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001317659 Donovan Michael C/O WELSH, CARSON, ANDERSON AND STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001556077 REGAN BRIAN THOMAS C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001434789 Ecock Anthony F C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 0001608207 Solomon Christopher C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 Common Stock 2015-11-18 4 S 0 2731638 41.75 D 5644975 D The securities reported as directly beneficially owned by the designated Reporting Person may be deemed to be indirectly beneficially owned by each of the Reporting Owners listed below, each of whom is a managing member of the sole general partner of the designated Reporting Person. Pursuant to Instruction 4(b)(iv) of Form 4, each such individual has elected to report as indirectly beneficially owned the entire number of securities owned by the designated Reporting Person, however each of them disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. Each Reporting Owner listed below also indirectly beneficially owns 59,986 shares of Common Stock held by WCAS Capital Partners IV, L.P. Such individuals are managing members of the sole general partner of WCAS Capital Partners IV, L.P. Pursuant to Instruction 4(b)(iv) of Form 4, each such individual has elected to report as indirectly beneficially owned the entire number of securities owned by such entity, however each of them disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. Each Reporting Owner listed below also directly beneficially owns the following shares of Common Stock: Patrick J. Welsh - 215,270; Russell L. Carson - 179,801; Bruce K. Anderson - 215,270; Robert A. Minicucci - 303,551; Anthony J. deNicola - 443,410 (also indirectly beneficially owns 71,877 shares held by deNicola Holdings II LLC, but disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein); Paul B. Queally - 421,846 (also indirectly beneficially owns 93,441 shares held by The Queally Family LLC, but disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein) ; Sanjay Swani - 221,036 (also indirectly beneficially owns 50,134 shares held by The Swani Family LLC, but disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein); Michael E. Donovan- 40,740; Tony F. Ecock - 22,619; Brian T. Regan -8,771; and Christopher W. Solomon - 3,089. Remarks: Form 2 of 2 /s/ David Mintz, Attorney-in-Fact 2015-11-18