0001683168-21-001209.txt : 20210402 0001683168-21-001209.hdr.sgml : 20210402 20210402133731 ACCESSION NUMBER: 0001683168-21-001209 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210331 FILED AS OF DATE: 20210402 DATE AS OF CHANGE: 20210402 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Newcomer Mark CENTRAL INDEX KEY: 0001506415 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-38623 FILM NUMBER: 21801402 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: 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/A 1 ownership.xml X0306 4/A 2021-03-31 2021-04-01 0 0001496443 Paysign, Inc. PAYS 0001506415 Newcomer Mark 2615 ST. ROSE PKWY HENDERSON NV 89052 1 1 1 0 CEO Common Stock 2021-03-31 2021-03-31 4 A 0 100000 A 9299741 D Common Stock 2021-04-01 2021-04-01 4 F 0 37300 4.4544 D 9262441 D Stock Grant 2021-03-31 2021-03-31 4 C 0 100000 D Common Stock 200000 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, 1.8 million shares granted have vested and been issued. Not applicable. /s/ Mark Newcomer 2021-04-02