SEC FORM 4 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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1. Name and Address of Reporting Person*
Miller Melissa F. (Missy)

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

(Street)
LEHI UT 84043

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Waystar Holding Corp. [ WAY ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
checkbox checked Officer (give title below) Other (specify below)
Chief Marketing Officer
3. Date of Earliest Transaction (Month/Day/Year)
05/01/2024
4. 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
Rule 10b5-1(c) Transaction Indication

checkbox unchecked 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
Common Stock 06/10/2024 A(1) 43,478 A $0 43,478(2) D
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
Stock Options (right to buy) $37.2 05/01/2024 A(3) 30,250 (3) 05/01/2034 Common Stock 30,250 $0 30,250 D
Stock Options (right to buy) $21.5 06/06/2024 A(4) 108,695 (4) 06/06/2034 Common Stock 108,695 $0 108,695 D
Explanation of Responses:
1. Reflects a grant of restricted stock units ("RSUs") which vest in five substantially equal annual installments commencing on June 6, 2025. Each RSU represents a contingent right to receive one share of common stock, $0.01 par value per share (the "Common Stock") upon settlement.
2. Includes unvested RSUs.
3. On May 1, 2024 reporting person was granted options to purchase shares of Common Stock which vest in three substantially equal annual installments commencing on May 1, 2025. Such securities were originally included on the Form 3 filed by the reporting person on June 7, 2024. Reflects the 0.605-for-1 reverse stock split which became effective on May 15, 2024.
4. On June 6, 2024 reporting person was granted options to purchase shares of Common Stock which vest in five substantially equal annual installments commencing on June 6, 2025. Such securities were originally included on the Form 3 filed by the reporting person on June 7, 2024.
/s/ Matthew R. A. Heiman, as Attorney-in-Fact 06/12/2024
** 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 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).
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