Sec Form 4 Filing - GTCR INVESTMENT XI LLC @ Paya Holdings Inc. - 2021-03-22

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
GTCR INVESTMENT XI LLC
2. Issuer Name and Ticker or Trading Symbol
Paya Holdings Inc. [ PAYA]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
300 NORTH LASALLE STREET, SUITE 5600
3. Date of Earliest Transaction (MM/DD/YY)
03/22/2021
(Street)
CHICAGO, IL60654
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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
Common Stock 03/22/2021 S 10,000,000 ( 1 ) D 45,234,022 I See footnote ( 2 ) ( 3 )
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
GTCR INVESTMENT XI LLC
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO, IL60654
X X
GTCR PARTNERS XI/B LP
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO, IL60654
X
GTCR PARTNERS XI/A&C LP
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO, IL60654
X
GTCR FUND XI/B LP
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO, IL60654
X
GTCR FUND XI/C LP
300 NORTH LASALLE STREET
SUITE 5600
CHICAGO, IL60654
X
Signatures
GTCR INVESTMENT XI LLC, By: /s/ Jeffrey S. Wright, by power of attorney 03/24/2021
Signature of Reporting Person Date
GTCR PARTNERS XI/B LP, By: /s/ Jeffrey S. Wright, by power of attorney 03/24/2021
Signature of Reporting Person Date
GTCR PARTNERS XI/A&C LP, By: /s/ Jeffrey S. Wright, by power of attorney 03/24/2021
Signature of Reporting Person Date
GTCR FUND XI/B LP, By: /s/ Jeffrey S. Wright, by power of attorney 03/24/2021
Signature of Reporting Person Date
GTCR FUND XI/C LP, By: /s/ Jeffrey S. Wright, by power of attorney 03/24/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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.
( 2 )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).
( 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.

Remarks:
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.

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