# EDGAR Filing Document

**Accession Number:** 0001805608
**File Stem:** 0000899243-23-004974
**Filing Date:** 2023-2
**Character Count:** 10267
**Document Hash:** 82fdb38bdbe779634fdde40482f2766f
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0000899243-23-004974.hdr.sgml**: 20230214

**ACCESSION NUMBER**: 0000899243-23-004974

**CONFORMED SUBMISSION TYPE**: 5

**PUBLIC DOCUMENT COUNT**: 2

**CONFORMED PERIOD OF REPORT**: 20221231

**FILED AS OF DATE**: 20230214

**DATE AS OF CHANGE**: 20230214

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Isaacman Jared
- **CENTRAL INDEX KEY:** 0001805608

**FILING VALUES:**
- **FORM TYPE:** 5
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-39313
- **FILM NUMBER:** 23628827

**MAIL ADDRESS:**
- **STREET 1:** C/O SHIFT4 PAYMENTS, INC.
- **STREET 2:** 2202 N. IRVING STREET
- **CITY:** ALLENTOWN
- **STATE:** PA
- **ZIP:** 18109
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Shift4 Payments, Inc.
- **CENTRAL INDEX KEY:** 0001794669
- **STANDARD INDUSTRIAL CLASSIFICATION:** SERVICES-BUSINESS SERVICES, NEC [7389]
- **IRS NUMBER:** 000000000
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 2202 NORTH IRVING STREET
- **CITY:** ALLENTOWN
- **STATE:** PA
- **ZIP:** 18109
- **BUSINESS PHONE:** 888.276.2108 X1220

**MAIL ADDRESS:**
- **STREET 1:** 2202 NORTH IRVING STREET
- **CITY:** ALLENTOWN
- **STATE:** PA
- **ZIP:** 18109

## Ex-24

```
<PRE>
                                                                      Exhibit 24

                          SECTION 16 POWER OF ATTORNEY

       With respect to holdings of and transactions in securities issued by
Shift4 Payments, Inc. (the "Company"), the undersigned hereby constitutes and
appoints the officers of the Company listed on Schedule A attached hereto and as
may be amended from time to time, or any of them signing singly, with full power
of substitution and resubstitution, to act as the undersigned's true and lawful
attorney- in-fact to:

1.   execute for and on behalf of the undersigned, Forms 3, 4, and 5 in
     accordance with Section 16 of the Securities Exchange Act of 1934, as
     amended, and the rules thereunder;

2.   do and perform any and all acts for and on behalf of the undersigned which
     may be necessary or desirable to complete and execute any such Form 3, 4,
     or 5, complete and execute any amendment or amendments thereto, and timely
     file such form with the United States Securities and Exchange Commission
     and any stock exchange or similar authority; and

3.   take any other action of any type whatsoever in connection with the
     foregoing which, in the opinion of such attorney-in-fact, may be of benefit
     to, in the best interest of, or legally required by, the undersigned, it
     being understood that the documents executed by such 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 such attorney-in-
     fact may approve in the discretion of such attorney-in-fact.

       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 and resubstitution or revocation, hereby ratifying and confirming
all that such attorney-in-fact, or such attorney-in-facts 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 attorneys-in-fact, in serving in
such capacity at the request of the undersigned, are not assuming, nor is any
Company assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934, as amended.

       This 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 respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.

       IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this 5th day of June, 2020.

                                                /s/ Jared Isaacman
                                                ---------------------
                                                Jared Isaacman

Schedule A

Individuals Appointed as Attorney-in-Fact with Full Power of Substitution and
Resubstitution

1.   Nancy Disman         Chief Financial Officer
2.   Jordan Frankel       Secretary, General Counsel and Executive Vice
                          President, Legal, Human Resources and Compliance

</PRE>
```

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 5

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] 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**<sup>*</sup><br>Isaacman Jared<br><sub>(Last) (First) (Middle)</sub><br>2202 N. IRVING ST<br><sub>(Street)</sub><br>ALLENTOWN, PA 18109<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2022-12-31 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Chairman & CEO_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Shift4 Payments, Inc. [ FOUR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Class C Common Stock | 2022-01-31 |  | G |  | 523231 | D | $0.00 | 3825584 | I | See footnote<sup>(1)</sup> |
| Class C Common Stock | 2022-01-31 |  | G |  | 209293 | D | $0.00 | 3616291 | I | See footnote<sup>(1)</sup> |
| Class C Common Stock | 2022-05-02 |  | G |  | 117216 | D | $0.00 | 3499075 | I | See footnote<sup>(1)</sup> |
| Class C Common Stock | 2022-06-05 |  | G |  | 20517 | D | $0.00 | 3478558 | I | See footnote<sup>(1)</sup> |
| Class C Common Stock | 2022-06-30 |  | G |  | 715717 | D | $0.00 | 2762841 | I | See footnote<sup>(1)</sup> |
| Class C Common Stock | 2022-08-31 |  | G |  | 5520 | D | $0.00 | 2757321 | I | See footnote<sup>(1)</sup> |
| Class C Common Stock | 2022-09-30 |  | G |  | 12507 | D | $0.00 | 2744814 | I | See footnote<sup>(1)</sup> |
| Class C Common Stock | 2022-09-30 |  | G |  | 5604 | D | $0.00 | 2739210 | I | See footnote<sup>(1)</sup> |
| Class C Common Stock | 2022-12-13 |  | G |  | 21221 | D | $0.00 | 2717989 | I | See footnote<sup>(1)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

---

### Footnotes:

(1) Securities held of record by Rook Holdings, Inc. ("Rook"). Mr. Isaacman is the sole stockholder of Rook and therefore may be deemed to have beneficial ownership with respect to such securities.

**Remarks:**
Exhibit 24 - Power of Attorney

**Signature:** /s/ Jordan Frankel, Attorney-in-Fact for Jared Isaacman  
**Date:** 2023-02-14

### Remarks:

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.**