0001683168-19-001483.txt : 20190513
0001683168-19-001483.hdr.sgml : 20190513
20190513122611
ACCESSION NUMBER: 0001683168-19-001483
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190510
FILED AS OF DATE: 20190513
DATE AS OF CHANGE: 20190513
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Triplett Dennis L
CENTRAL INDEX KEY: 0001740589
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38623
FILM NUMBER: 19817573
MAIL ADDRESS:
STREET 1: 1700 HORIZON RIDGE PARKWAY, #200
CITY: HENDERSON
STATE: NV
ZIP: 89012
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
2019-05-10
0
0001496443
Paysign, Inc.
PAYS
0001740589
Triplett Dennis L
1700 W. HORIZON RIDGE PKWY., #200
HENDERSON
NV
89012
1
0
0
0
Common Stock
2019-05-10
4
A
0
50000
A
50000
D
Stock Grant
2019-05-10
2019-05-10
4
C
0
50000
D
Common Stock
50000
150000
D
Not Applicable
Not Applicable
On May 3, 2018 received grant of 200,000 shares of Common Stock, vesting in equal parts over a 4 year period on each anniversary date in which Director is still serving in his/ her capacity. Including this issuance, as of May 10, 2019, 50,000 shares of the 200,000 granted have vested and been issued.
/s/ Dennis L. Triplett
2019-05-13