0001171843-17-001779.txt : 20170327
0001171843-17-001779.hdr.sgml : 20170327
20170327185039
ACCESSION NUMBER: 0001171843-17-001779
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170317
FILED AS OF DATE: 20170327
DATE AS OF CHANGE: 20170327
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: PAYMENT DATA SYSTEMS INC
CENTRAL INDEX KEY: 0001088034
STANDARD INDUSTRIAL CLASSIFICATION: FUNCTIONS RELATED TO DEPOSITORY BANKING, NEC [6099]
IRS NUMBER: 980190072
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 12500 SAN PEDRO
STREET 2: SUITE 120
CITY: SAN ANTONIO
STATE: TX
ZIP: 78216
BUSINESS PHONE: 2102494100
MAIL ADDRESS:
STREET 1: 12500 SAN PEDRO
STREET 2: STE 120
CITY: SAN ANTONIO
STATE: TX
ZIP: 78216
FORMER COMPANY:
FORMER CONFORMED NAME: BILLSERV INC
DATE OF NAME CHANGE: 20011219
FORMER COMPANY:
FORMER CONFORMED NAME: BILLSERV COM INC
DATE OF NAME CHANGE: 19990607
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Yunus Habib
CENTRAL INDEX KEY: 0001593490
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-15093
FILM NUMBER: 17716444
MAIL ADDRESS:
STREET 1: 12500 SAN PEDRO
STREET 2: SUITE 120
CITY: SAN ANTONIO
STATE: TX
ZIP: 78216
4
1
formfour.xml
OWNERSHIP DOCUMENT
X0306
4
2017-03-17
0
0001088034
PAYMENT DATA SYSTEMS INC
PYDS
0001593490
Yunus Habib
12500 SAN PEDRO, STE 120
SAN ANTONIO
TX
78216
0
0
0
1
Former SVP/CFO
Common Stock, $0.001 per share
2017-03-17
4
J
0
266667
D
0
D
Common Stock, $0.001 per share
2017-03-17
4
A
0
35920
A
35920
D
The vesting of these previously granted shares was forfeited as a result of the termination of the employment relationship.
53,334 shares were granted by the issuer pursuant to a separation agreement. The shares were issued net of 17,414 shares to cover taxes.
/s/ Habib Yunus
2017-03-27