SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
DRISCOLL JOHN PATRICK

(Last) (First) (Middle)
1550 DIGITAL DRIVE, #300

(Street)
LEHI UT 84043

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/07/2024
3. Issuer Name and Ticker or Trading Symbol
Waystar Holding Corp. [ WAY ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
checkbox checked Director 10% Owner
Officer (give title below) checkbox checked Other (specify below)
Chairperson
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
checkbox checked Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 70,928 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (right to buy) (1) 12/04/2029 Common Stock 160,101 16.53 D
Stock Options (right to buy) (2) 08/09/2030 Common Stock 81,898 18.19 D
Explanation of Responses:
1. Options granted on December 4, 2019 which vest in five substantially equal annual installments commencing on October 22, 2020.
2. Options granted on August 9, 2020 which vest in five substantially equal annual installments commencing on August 9, 2021.
Remarks:
Exhibit 24 - Power of Attorney.
/s/ Matthew R. A. Heiman, as Attorney-in-Fact 06/07/2024
** 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 5 (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.
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Exhibit 24

 

Power of Attorney

 

Know all by these presents that the undersigned, does hereby make, constitute and appoint each of MATTHEW R. A. HEIMAN and STEVEN M. ORESKOVICH, or any one of them, as a true and lawful attorney-in-fact of the undersigned with full powers of substitution and revocation, for and in the name, place and stead of the undersigned (in the undersigned’s individual capacity), to execute and deliver such forms that the undersigned may be required to file with the U.S. Securities and Exchange Commission as a result of the undersigned’s ownership of or transactions in securities of WAYSTAR HOLDING CORP. (i) pursuant to Section 16(a) of the Securities Exchange Act of 1934, as amended, including without limitation, statements on Form 3, Form 4 and Form 5 (including any amendments thereto) and (ii) in connection with any applications for EDGAR access codes, including without limitation the Form ID. The Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with regard to his or her ownership of or transactions in securities of WAYSTAR HOLDING CORP., unless earlier revoked in writing. The undersigned acknowledges that MATTHEW R. A. HEIMAN and STEVEN M. ORESKOVICH are not assuming any of the undersigned’s responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended.

 

  By: /s/ John Patrick Driscoll
  Name: John Patrick Driscoll
     
Date: May 21, 2024