0001213900-21-017413.txt : 20210324
0001213900-21-017413.hdr.sgml : 20210324
20210324091649
ACCESSION NUMBER: 0001213900-21-017413
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210322
FILED AS OF DATE: 20210324
DATE AS OF CHANGE: 20210324
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GTCR FUND XI/B LP
CENTRAL INDEX KEY: 0001591435
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39627
FILM NUMBER: 21766804
BUSINESS ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
BUSINESS PHONE: (312) 382-2200
MAIL ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GTCR FUND XI/C LP
CENTRAL INDEX KEY: 0001591436
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39627
FILM NUMBER: 21766803
BUSINESS ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
BUSINESS PHONE: (312) 382-2200
MAIL ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GTCR PARTNERS XI/A&C LP
CENTRAL INDEX KEY: 0001828028
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39627
FILM NUMBER: 21766805
BUSINESS ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
BUSINESS PHONE: (312) 382-2200
MAIL ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GTCR PARTNERS XI/B LP
CENTRAL INDEX KEY: 0001827959
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39627
FILM NUMBER: 21766806
BUSINESS ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
BUSINESS PHONE: (312) 382-2200
MAIL ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GTCR INVESTMENT XI LLC
CENTRAL INDEX KEY: 0001827977
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39627
FILM NUMBER: 21766807
BUSINESS ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
BUSINESS PHONE: (312) 382-2200
MAIL ADDRESS:
STREET 1: 300 NORTH LASALLE STREET, SUITE 5600
CITY: CHICAGO
STATE: IL
ZIP: 60654
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Paya Holdings Inc.
CENTRAL INDEX KEY: 0001819881
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389]
IRS NUMBER: 852199433
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 303 PERIMETER CENTER NORTH
STREET 2: SUITE 600
CITY: ATLANTA
STATE: GA
ZIP: 30346
BUSINESS PHONE: (800) 261-0240
MAIL ADDRESS:
STREET 1: 303 PERIMETER CENTER NORTH
STREET 2: SUITE 600
CITY: ATLANTA
STATE: GA
ZIP: 30346
FORMER COMPANY:
FORMER CONFORMED NAME: FINTECH ACQUISITION CORP III PARENT CORP
DATE OF NAME CHANGE: 20200731
4
1
ownership.xml
X0306
4
2021-03-22
0
0001819881
Paya Holdings Inc.
PAYA
0001827977
GTCR INVESTMENT XI LLC
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO
IL
60654
1
0
1
0
0001827959
GTCR PARTNERS XI/B LP
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO
IL
60654
0
0
1
0
0001828028
GTCR PARTNERS XI/A&C LP
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO
IL
60654
0
0
1
0
0001591435
GTCR FUND XI/B LP
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO
IL
60654
0
0
1
0
0001591436
GTCR FUND XI/C LP
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO
IL
60654
0
0
1
0
Common Stock
2021-03-22
4
S
0
10000000
D
45234022
I
See footnote
Represents common stock of Paya Holdings Inc. (the "Issuer") sold by GTCR-Ultra Holdings, LLC ("Ultra") pursuant to the offering of Issuer common stock on Form S-1 as contemplated by that certain underwriting agreement, dated March 17, 2021, among the Issuer, Ultra and the underwriters named therein. The selling price of such shares was $11.72937 per share, which represents the price to public less the underwriting discount.
Voting and dispositive power with respect to the shares of common stock held by Ultra is exercised by GTCR Investment XI LLC ("Investment XI"). Voting and dispositive power with respect to the shares of common stock held by Fund XI/B is exercised by its general partner, GTCR Partners XI/B LP ("Partners XI/B"). Voting and dispositive power with respect to the shares of common stock held by Fund XI/C is exercised by its general partner, GTCR Partners XI/A&C LP ("Partners XI/A&C"). Investment XI is the general partner of each of Co-Invest, Partners XI/B and Partners XI/A&C. GTCR Investment XI LLC is managed by an eight-member board of managers (the "GTCR Board of Managers") (Continued in Footnote 3).
Each of the foregoing entities and the individual members of the GTCR Board of Managers disclaims beneficial ownership of the shares reported hereby, except to the extent of their pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.
Investment XI, acting through Fund XI/B and Fund XI/C, has the right to designate up to five nominees for election to the board of directors of the Issuer. Aaron Cohen, KJ McConnell, Collin Roche, Anna May Trala and Jim Bonetti currently serve on the board of directors of the Issuer as the designees of Investment XI.
GTCR INVESTMENT XI LLC, By: /s/ Jeffrey S. Wright, by power of attorney
2021-03-24
GTCR PARTNERS XI/B LP, By: /s/ Jeffrey S. Wright, by power of attorney
2021-03-24
GTCR PARTNERS XI/A&C LP, By: /s/ Jeffrey S. Wright, by power of attorney
2021-03-24
GTCR FUND XI/B LP, By: /s/ Jeffrey S. Wright, by power of attorney
2021-03-24
GTCR FUND XI/C LP, By: /s/ Jeffrey S. Wright, by power of attorney
2021-03-24