0001144204-17-016457.txt : 20170324
0001144204-17-016457.hdr.sgml : 20170324
20170324130328
ACCESSION NUMBER: 0001144204-17-016457
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20161031
FILED AS OF DATE: 20170324
DATE AS OF CHANGE: 20170324
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: JetPay Corp
CENTRAL INDEX KEY: 0001507986
STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770]
IRS NUMBER: 900632274
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1175 LANCASTER AVE., SUITE 200
CITY: BERWYN
STATE: PA
ZIP: 19312
BUSINESS PHONE: 6109772482
MAIL ADDRESS:
STREET 1: 1175 LANCASTER AVE., SUITE 200
CITY: BERWYN
STATE: PA
ZIP: 19312
FORMER COMPANY:
FORMER CONFORMED NAME: Universal Business Payment Solutions Acquisition Corp
DATE OF NAME CHANGE: 20101215
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FARO DIANE
CENTRAL INDEX KEY: 0001605299
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35170
FILM NUMBER: 17712008
MAIL ADDRESS:
STREET 1: 1175 LANCASTER AVENUE
STREET 2: SUITE 100
CITY: BERWYN
STATE: PA
ZIP: 19312
4
1
v462603_form4.xml
OWNERSHIP DOCUMENT
X0306
4
2016-10-31
0
0001507986
JetPay Corp
JTPY
0001605299
FARO DIANE
3939 WEST DRIVE
CENTE VALLEY
PA
18034
1
1
0
0
Chief Executive Officer
Stock Option (Right to Buy)
2.60
2016-10-31
4
A
0
350000
0
A
2026-11-01
Common Stock
350000
350000
D
The stock options vest ratably on a daily basis over the period commencing on October 31, 2016 and ending May 5, 2018.
/s/ Gregory M. Krzemien, Attorney in Fact
2017-03-24