0001683168-20-001435.txt : 20200507 0001683168-20-001435.hdr.sgml : 20200507 20200507080633 ACCESSION NUMBER: 0001683168-20-001435 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200504 FILED AS OF DATE: 20200507 DATE AS OF CHANGE: 20200507 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: 20854660 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 2020-05-04 0 0001496443 Paysign, Inc. PAYS 0001740589 Triplett Dennis L 1700 W. HORIZON RIDGE PKWY., #200 HENDERSON NV 89012 1 0 0 0 Common Stock 2020-05-04 2020-05-04 4 A 0 50000 A 100000 D Stock Grant 2020-05-04 2020-05-04 4 C 0 50000 D Common Stock 100000 D On May 3, 2018 received 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. Not applicable /s/ Dennis L. Triplett 2020-05-06