SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP


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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Isaacman Jared

(Last) (First) (Middle)
2202 N. IRVING ST.

(Street)
ALLENTOWN PA 18109

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Shift4 Payments, Inc. [ FOUR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chairman & CEO
3. Date of Earliest Transaction (Month/Day/Year)
06/22/2023
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Rule 10b5-1(c) Transaction Indication

  
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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 C Common Stock 01/17/2023 G(1) 799,105 D $0 1,918,884 I See footnote(2)
Class C Common Stock 06/22/2023 G(3) 308,756 D $0.00 1,610,128 I See footnote(2)
Class C Common Stock 06/22/2023 G(4) 22,677 D $0.00 1,587,451 I See footnote(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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. The transaction reported shows the Reporting Person's charitable gift of 799,105 shares of Issuer's Class A common stock to St. Jude Children's Research Hospital (and the simultaneous cancellation of the same number of shares of the Issuer's Class C Common stock) as part of a previously announced giving pledge, pursuant to which the Reporting Person announced the intention to make charitable donations to St. Jude Children's Hospital.
2. Securities held of record by Rook Holdings, Inc. ("Rook"). The Reporting Person, Mr. Isaacman, is the sole stockholder of Rook and therefore may be deemed to have beneficial ownership with respect to such securities.
3. The transaction reported shows the Reporting Person's charitable gift of 308,756 shares of Issuer's Class A common stock to St. Jude Children's Research Hospital (and the simultaneous cancellation of the same number of shares of the Issuer's Class C Common stock) as part of a previously announced giving pledge, pursuant to which the Reporting Person announced the intention to make charitable donations to St. Jude Children's Hospital. This charitable gift is the final gift and completes the Reporting Person's intended donations under such pledge.
4. The transaction reported shows the Reporting Person's charitable gift of 22,677 shares of Issuer's Class A common stock to Renaissance Charitable Foundation, Inc. (and the simultaneous cancellation of the same number of shares of the Issuer's Class C Common stock) as part of a previously announced giving pledge by the Reporting Person in conjunction with the Caring for Crypto Campaign. This charitable gift is the final gift and completes the Reporting Person's intended donations under such pledge.
/s/ Jordan Frankel, Attorney-in-Fact for Jared Isaacman 06/26/2023
** 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 4 (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.