0001683168-22-003204.txt : 20220504 0001683168-22-003204.hdr.sgml : 20220504 20220504192724 ACCESSION NUMBER: 0001683168-22-003204 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220503 FILED AS OF DATE: 20220504 DATE AS OF CHANGE: 20220504 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: 22893398 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: 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 2022-05-03 0 0001496443 Paysign, Inc. PAYS 0001740589 Triplett Dennis L 2615 SAINT ROSE PARKWAY HENDERSON NV 89052 1 0 0 0 Common Stock 2022-05-03 4 A 0 50000 A 200000 D Stock Grant 2022-05-03 2022-05-03 4 M 0 50000 D Common Stock 0 D On May 3, 2018, Mr. Triplett received a grant of 200,000 shares of Common Stock, vesting in equal parts over a 4 year period on each anniversary date on which Mr. Triplett is still serving as a director Not applicable /s/ Dennis L. Triplett 2022-05-03