0001144204-18-006374.txt : 20180207 0001144204-18-006374.hdr.sgml : 20180207 20180207173017 ACCESSION NUMBER: 0001144204-18-006374 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171115 FILED AS OF DATE: 20180207 DATE AS OF CHANGE: 20180207 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KRZEMIEN GREGORY M CENTRAL INDEX KEY: 0001267757 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35170 FILM NUMBER: 18582072 MAIL ADDRESS: STREET 1: 1000 CRAWFORD PL STREET 2: SUITE 400 CITY: MT LAUREL STATE: NJ ZIP: 08054 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: JetPay Corp CENTRAL INDEX KEY: 0001507986 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 900632274 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1175 LANCASTER AVE., SUITE 200 CITY: BERWYN STATE: PA ZIP: 19312 BUSINESS PHONE: 6109772482 MAIL ADDRESS: STREET 1: 1175 LANCASTER AVE., SUITE 200 CITY: BERWYN STATE: PA ZIP: 19312 FORMER COMPANY: FORMER CONFORMED NAME: Universal Business Payment Solutions Acquisition Corp DATE OF NAME CHANGE: 20101215 4 1 tv485106_4.xml OWNERSHIP DOCUMENT X0306 4 2017-11-15 0 0001507986 JetPay Corp JTPY 0001267757 KRZEMIEN GREGORY M 3939 WEST DRIVE CENTER VALLEY PA 18034 0 1 0 0 Chief Financial Officer Stock Option (Right to Buy) 3.00 2017-11-15 4 A 0 100000 0 A 2027-11-15 Common Stock 100000 100000 D The stock options vest ratably on a monthly basis over the period commencing on November 15, 2017 and ending November 15, 2019. /s/ Gregory M. Krzemien 2018-02-07