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