0001683168-20-000021.txt : 20200103 0001683168-20-000021.hdr.sgml : 20200103 20200103191803 ACCESSION NUMBER: 0001683168-20-000021 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191231 FILED AS OF DATE: 20200103 DATE AS OF CHANGE: 20200103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Newcomer Mark CENTRAL INDEX KEY: 0001506415 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38623 FILM NUMBER: 20507649 MAIL ADDRESS: STREET 1: 1700 W HORIZON RIDGE PARKWAY STE 2 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 2019-12-31 0 0001496443 Paysign, Inc. PAYS 0001506415 Newcomer Mark 1700 W. HORIZON RIDGE PARKWAY, STE 200 HENDERSON NV 89012 1 1 1 0 CEO Common Stock 2019-12-31 2019-12-31 4 A 0 100000 A 8998089 D Common Stock 2020-01-02 2020-01-02 4 F 0 40000 9.8436 D 8958089 D Common Stock 2020-01-03 2020-01-03 4 F 0 593 9.4398 D 8957496 D Stock Grant 2019-12-31 2019-12-31 4 C 0 100000 D Common Stock 700000 D 100% of sale proceeds delivered to company for employee tax withholdings. On 11/11/16 received grant of 2 million shares of Common Stock vesting in equal amounts over a 5 year period on the last day of each quarter if employed by company at that time. As of the date of this filing, 1.3 million shares granted have vested and been issued. Not applicable. /s/ Mark Newcomer 2020-01-03