Initial Statement of Beneficial Ownership (3)
September 20 2019 - 5:47PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Walker Karen Sammis |
2. Date of Event Requiring Statement (MM/DD/YYYY)
9/18/2019
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3. Issuer Name and Ticker or Trading Symbol
PagerDuty, Inc. [PD]
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(Last)
(First)
(Middle)
C/O PAGERDUTY, INC., 600 TOWNSEND ST., STE. 200 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Principal Accounting Officer / |
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(Street)
SAN FRANCISCO, CA 94103
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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) | 4/1/2029 | Common Stock | 195000.00 | $20.00 | D | |
| Stock Options (Right to buy) | (2) | 6/20/2029 | Common Stock | 19500.00 | $53.79 | D | |
| Explanation of Responses: |
| (1) | All shares underlying this option are immediately exercisable, subject to a repurchase right in the Issuer's favor which lapses in accordance with the option's vesting schedule. 25% of the shares shall vest on March 27, 2020 and the remaining shall vest in 1/36th monthly installments thereafter, subject to the Reporting Person providing continuous service to the Issuer on each such date. |
| (2) | The option becomes exercisable as follows: 25% of the shares shall vest on June 20, 2020 and the remaining shall vest in 1/12th quarterly installments thereafter, subject to the Reporting Person providing continuous service to the Issuer on each such date. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Walker Karen Sammis
C/O PAGERDUTY, INC.
600 TOWNSEND ST., STE. 200
SAN FRANCISCO, CA 94103 |
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| Principal Accounting Officer |
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Signatures
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| /s /Stacey A. Giamalis, Attorney-in-Fact for Karen Sammis Walker | | 9/20/2019 |
| **Signature of Reporting Person | Date |
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