0001683168-19-003047.txt : 20190925 0001683168-19-003047.hdr.sgml : 20190925 20190925175449 ACCESSION NUMBER: 0001683168-19-003047 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190923 FILED AS OF DATE: 20190925 DATE AS OF CHANGE: 20190925 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HENRY DANIEL R CENTRAL INDEX KEY: 0001253706 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38623 FILM NUMBER: 191115120 MAIL ADDRESS: STREET 1: 13160 BIRCH CITY: OVERLAND PARK STATE: KS ZIP: 66211 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Paysign, Inc. CENTRAL INDEX KEY: 0001496443 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 954550154 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1700 W HORIZON RIDGE PARKWAY STREET 2: SUITE 200 CITY: HENDERSON STATE: NV ZIP: 89012 BUSINESS PHONE: 702-453-2221 MAIL ADDRESS: STREET 1: 1700 W HORIZON RIDGE PARKWAY STREET 2: SUITE 200 CITY: HENDERSON STATE: NV ZIP: 89012 FORMER COMPANY: FORMER CONFORMED NAME: 3PEA INTERNATIONAL, INC. DATE OF NAME CHANGE: 20100713 4 1 ownership.xml X0306 4 2019-09-23 0 0001496443 Paysign, Inc. TPNL 0001253706 HENRY DANIEL R 1700 W. HORIZON RIDGE PKWY, #200 HENDERSON NV 89012 1 0 0 0 Common Stock 2019-09-23 2019-09-23 4 M 0 14308 1.34 A 14308 D Common Stock 2019-09-23 2019-09-23 4 S 0 14308 11.01 D 0 D Common Stock 2019-09-24 2019-09-24 4 M 0 1100 1.34 A 1100 D Common Stock 2019-09-24 2019-09-24 4 S 0 1100 11.03 D 0 D Stock Options 1.34 2019-09-23 2019-09-23 4 M 0 14308 D Common Stock 14308 1483120 D Stock Options 1.34 2019-09-24 2019-09-24 4 M 0 1100 D Common Stock 1100 1482020 D Transaction was effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on August 21, 2019. On 5/3/18 received an option to purchase 1,500,000 shares of Common Stock for 5 years at $1.34, vesting in equal parts over a 4-year period annually during his service as a Director of the Paysign Board of Directors. /s/ Daniel R. Henry 2019-09-25