0001683168-20-003597.txt : 20201029 0001683168-20-003597.hdr.sgml : 20201029 20201029204135 ACCESSION NUMBER: 0001683168-20-003597 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200904 FILED AS OF DATE: 20201029 DATE AS OF CHANGE: 20201029 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Herman Joan M CENTRAL INDEX KEY: 0001717123 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38623 FILM NUMBER: 201274364 MAIL ADDRESS: STREET 1: 1700 W. 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: 2615 ST. ROSE PARKWAY CITY: HENDERSON STATE: NV ZIP: 89052 BUSINESS PHONE: 702-453-2221 MAIL ADDRESS: STREET 1: 2615 ST. ROSE PARKWAY CITY: HENDERSON STATE: NV ZIP: 89052 FORMER COMPANY: FORMER CONFORMED NAME: 3PEA INTERNATIONAL, INC. DATE OF NAME CHANGE: 20100713 4 1 ownership.xml X0306 4 2020-09-04 0 0001496443 Paysign, Inc. PAYS 0001717123 Herman Joan M 2615 ST. ROSE PKWY HENDERSON NV 89052 1 1 0 0 Chief Operating Officer Common Stock 2020-09-04 2020-09-04 4 A 0 200000 A 719808 D Common Stock 2020-09-08 2020-09-08 4 F 0 83193 5.7183 D 636615 D Stock Grant 2020-09-04 2020-09-04 4 C 0 200000 D Common Stock 200000 D 100% of sale proceeds delivered to company for employee tax withholdings. On 6/29/17 received grant of 1 million shares of Common Stock. 200k vested on date of employment 9/4/17; 200k vested on each subsequent one year period over four years. Not applicable. /s/ Joan M. Herman 2020-09-08