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