Form 4 - Statement of changes in beneficial ownership of securities
09 5월 2024 - 5:45AM
Edgar (US Regulatory)
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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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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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). |
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Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10. |
1. Name and Address of Reporting Person*
5360 LEGACY DRIVE BUILDING 2 |
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(Street)
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2. Issuer Name and Ticker or Trading Symbol
Katapult Holdings, Inc.
[ KPLT ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
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Chief Executive Officer |
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3. Date of Earliest Transaction
(Month/Day/Year) 05/06/2024
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
05/06/2024 |
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A |
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26,500
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A |
$0
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151,819 |
D |
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of Responses: |
Remarks: |
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/s/ Arthur Goss, as Attorney-in-Fact for Orlando Zayas |
05/08/2024 |
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** 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. |
EXHIBIT 24
POWER
OF ATTORNEY
(For
Executing Form ID and Forms 3, 4 and 5)
Know
all by these presents, that the undersigned hereby constitutes and appoints each of Derek Medlin, Kimberly Dasse, Arthur Goss, and Ryan
Wigdor of Katapult Holdings, Inc., a Delaware corporation (the “Company”) and Jennifer Conway and Nicole Brookshire
of Davis Polk & Wardwell, LLP, signing individually, the undersigned’s true and lawful attorneys-in fact and agents to:
| (1) | Prepare,
execute in the undersigned’s name and on the undersigned’s behalf, and submit
to the Securities and Exchange Commission (the “SEC”), a Form ID
and Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in connection
therewith) in accordance with Section 16 of the Securities Exchange Act of 1934, as amended
(the “Exchange Act”), and the rules thereunder, in the undersigned’s
capacity as an officer, director or beneficial owner of more than 10% of a registered class
of securities of the Company; |
| (2) | Do
and perform any and all acts for and on behalf of the undersigned that may be necessary or
desirable to prepare and execute any such Form ID and Forms 3, 4 or 5 (including amendments
thereto and joint filing agreements in connection therewith) and file such forms with the
SEC and any stock exchange, self-regulatory association or any similar authority; and |
| (3) | Take
any other action of any type whatsoever in connection with the foregoing that, in the opinion
of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required
of the undersigned, it being understood that the documents executed by the attorney-in-fact
on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and
shall contain such terms and conditions as the attorney-in-fact may approve in the attorney-in-fact’s
discretion. |
The
undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever
requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and
purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying
and confirming all that such attorney-in-fact, or such attorney-in-fact’s substitute or substitutes, shall lawfully do or cause
to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing
attorneys-in-fact, and their substitutes, in serving in such capacity at the request of the undersigned, are not assuming (nor is the
Company assuming) any of the undersigned’s responsibilities to comply with Section 16 of the Exchange Act.
This
Power of Attorney shall remain in full force and effect until the earliest to occur of (a) the undersigned is no longer required to file
Forms 3, 4 and 5 with respect to the undersigned’s holdings of and transactions in securities issued by the Company, (b) revocation
by the undersigned in a signed writing delivered to the Company and the foregoing attorneys-in fact or (c) as to any attorney-in-fact
individually, until such attorney-in-fact is no longer employed by the Company.
IN
WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of the date written below.
Date:
May 2, 2024 |
/s/
Orlando Zayas |
|
Orlando
Zayas |
EXHIBIT 24
POWER
OF ATTORNEY
(For
Executing Form ID and Forms 3, 4 and 5)
Know
all by these presents, that the undersigned hereby constitutes and appoints each of Derek Medlin, Kimberly Dasse, Arthur Goss, and Ryan
Wigdor of Katapult Holdings, Inc., a Delaware corporation (the “Company”) and Jennifer Conway and Nicole Brookshire
of Davis Polk & Wardwell, LLP, signing individually, the undersigned’s true and lawful attorneys-in fact and agents to:
| (1) | Prepare,
execute in the undersigned’s name and on the undersigned’s behalf, and submit
to the Securities and Exchange Commission (the “SEC”), a Form ID
and Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in connection
therewith) in accordance with Section 16 of the Securities Exchange Act of 1934, as amended
(the “Exchange Act”), and the rules thereunder, in the undersigned’s
capacity as an officer, director or beneficial owner of more than 10% of a registered class
of securities of the Company; |
| (2) | Do
and perform any and all acts for and on behalf of the undersigned that may be necessary or
desirable to prepare and execute any such Form ID and Forms 3, 4 or 5 (including amendments
thereto and joint filing agreements in connection therewith) and file such forms with the
SEC and any stock exchange, self-regulatory association or any similar authority; and |
| (3) | Take
any other action of any type whatsoever in connection with the foregoing that, in the opinion
of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required
of the undersigned, it being understood that the documents executed by the attorney-in-fact
on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and
shall contain such terms and conditions as the attorney-in-fact may approve in the attorney-in-fact’s
discretion. |
The
undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever
requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and
purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying
and confirming all that such attorney-in-fact, or such attorney-in-fact’s substitute or substitutes, shall lawfully do or cause
to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing
attorneys-in-fact, and their substitutes, in serving in such capacity at the request of the undersigned, are not assuming (nor is the
Company assuming) any of the undersigned’s responsibilities to comply with Section 16 of the Exchange Act.
This
Power of Attorney shall remain in full force and effect until the earliest to occur of (a) the undersigned is no longer required to file
Forms 3, 4 and 5 with respect to the undersigned’s holdings of and transactions in securities issued by the Company, (b) revocation
by the undersigned in a signed writing delivered to the Company and the foregoing attorneys-in fact or (c) as to any attorney-in-fact
individually, until such attorney-in-fact is no longer employed by the Company.
IN
WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of the date written below.
Date:
May 2, 2024 |
/s/
Orlando Zayas |
|
Orlando
Zayas |
Katapult (NASDAQ:KPLTW)
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Katapult (NASDAQ:KPLTW)
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