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