0000899243-21-033495.txt : 20210818 0000899243-21-033495.hdr.sgml : 20210818 20210818174655 ACCESSION NUMBER: 0000899243-21-033495 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210816 FILED AS OF DATE: 20210818 DATE AS OF CHANGE: 20210818 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Davis Karen Roter CENTRAL INDEX KEY: 0001878982 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39313 FILM NUMBER: 211187660 MAIL ADDRESS: STREET 1: C/O SHIFT4 PAYMENTS, INC. STREET 2: 2202 N. IRVING ST CITY: ALLENTOWN STATE: PA ZIP: 18109 FORMER NAME: FORMER CONFORMED NAME: David Karen Roter DATE OF NAME CHANGE: 20210817 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Shift4 Payments, Inc. CENTRAL INDEX KEY: 0001794669 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2202 NORTH IRVING STREET CITY: ALLENTOWN STATE: PA ZIP: 18109 BUSINESS PHONE: 888.276.2108 X1220 MAIL ADDRESS: STREET 1: 2202 NORTH IRVING STREET CITY: ALLENTOWN STATE: PA ZIP: 18109 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-08-16 0 0001794669 Shift4 Payments, Inc. FOUR 0001878982 Davis Karen Roter 2202 N. IRVING ST. ALLENTOWN PA 18109 1 0 0 0 Class A Common Stock 2021-08-16 4 A 0 1047 0.00 A 1047 D Represents an award of restricted stock units, which vest in full on the one year anniversary of the grant date. /s/ Jordan Frankel, Attorney-in-Fact for Karen Roter Davis 2021-08-18