0001683168-22-001389.txt : 20220302 0001683168-22-001389.hdr.sgml : 20220302 20220302204443 ACCESSION NUMBER: 0001683168-22-001389 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220228 FILED AS OF DATE: 20220302 DATE AS OF CHANGE: 20220302 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Baker Jeffery Bradford CENTRAL INDEX KEY: 0001851465 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38623 FILM NUMBER: 22706363 MAIL ADDRESS: STREET 1: 3101 HOWELL MILL RD. STREET 2: UNIT 223 CITY: ATLANTA STATE: GA ZIP: 3 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 2022-02-28 0 0001496443 Paysign, Inc. PAYS 0001851465 Baker Jeffery Bradford 2615 ST. ROSE PKWY HENDERSON NV 89052 0 1 0 0 Chief Financial Officer Common Stock 2022-02-28 4 M 0 60000 2.17 A 85000 D Common Stock 2022-03-01 4 S 0 26307 2.13 D 58693 D Stock Grant 2022-02-28 4 M 0 60000 A Common Stock 240000 D On January 6, 2021, the reporting person received a grant of 300,000 shares of common stock vesting annually in equal amounts over a five-year period commencing on February 28, 2022. As of the date of this filing, 60,000 shares of common stock have vested and been issued. The price reported in Column 4 is a weighted average price. The reporting person undertakes to provide to Paysign, Inc. (the "Company"), any security holder of the Company, or the staff of the Securities and Exchange Commission (the "SEC"), upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. These shares of common stock were sold to satisfy certain tax withholding obligations associated with the vesting of restricted stock. N/A /s/ Jeffrey B. Baker 2022-03-02