0001213900-21-025124.txt : 20210507 0001213900-21-025124.hdr.sgml : 20210507 20210507160847 ACCESSION NUMBER: 0001213900-21-025124 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210505 FILED AS OF DATE: 20210507 DATE AS OF CHANGE: 20210507 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Broenniman Philip R CENTRAL INDEX KEY: 0001781770 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-54545 FILM NUMBER: 21902695 MAIL ADDRESS: STREET 1: C/O CSS INDUSTRIES, INC. STREET 2: 450 PLYMOUTH ROAD, SUITE 300 CITY: PLYMOUTH MEETING STATE: PA ZIP: 19462 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Ipsidy Inc. CENTRAL INDEX KEY: 0001534154 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 670 LONG BEACH BLVD. CITY: LONG BEACH STATE: NY ZIP: 11561 BUSINESS PHONE: 516-274-8700 MAIL ADDRESS: STREET 1: 670 LONG BEACH BLVD. CITY: LONG BEACH STATE: NY ZIP: 11561 FORMER COMPANY: FORMER CONFORMED NAME: ID Global Solutions Corp DATE OF NAME CHANGE: 20141014 FORMER COMPANY: FORMER CONFORMED NAME: IIM Global Corp DATE OF NAME CHANGE: 20130107 FORMER COMPANY: FORMER CONFORMED NAME: Silverwood Acquisition Corp DATE OF NAME CHANGE: 20111102 4 1 ownership.xml X0306 4 2021-05-05 0 0001534154 Ipsidy Inc. IDTY 0001781770 Broenniman Philip R C/O IPSIDY INC., 670 LONG BEACH BLVD. LONG BEACH, NY 11561 1 1 0 0 President/COO Common Stock, $.0001 par value 5182412 D Common Stock, $.0001 par value 9153969 I See footnote Stock Options 0.24 2021-05-05 4 A 0 17662313 0.0 A 2021-05-05 2031-05-05 Common Stock, $0.0001 par value per share 17662313 17662313 D Warrants 0.15 2020-06-30 2022-06-30 Common Stock, $0.0001 par value per share 929167 929167 I See Footnotes Stock Options 0.07 2020-05-22 2025-05-22 Common Stock, $0.0001 par value per share 16666666 16666666 D Warrants 0.165 2018-08-15 2023-08-15 Common Stock, $0.0001 par value per share 350000 350000 D Warrants 0.088 2019-06-24 2024-06-23 Common Stock, $0.0001 par value per share 262500 262500 D Includes the right to acquire 1,500,000 shares of common stock at par value subject to the certain vesting criteria granted to Mr. Broenniman on March 6, 2020 pursuant to a Restricted Stock Purchase Agreement. Mr. Broenniman is the Managing Partner of Varana Capital, LLC ("Varana Capital"), which, in turn, is the investment manager of and has dispositive control over the shares held by Varana Capital Focused, LP ("VCFLP"). By virtue of these relationships, in addition to the shares he holds personally, Mr. Broenniman may be deemed to beneficially own the shares held by Varana Capital Focused, LP. On May 22, 2020, the Company granted Mr. Broenniman a Non-Statutory Option to acquire 16,666,666 shares of common stock at an exercise price of $0.07 per share with 3,333,333 shares vesting upon the grant of Non-Statutory Option, 5,333,333 shares vesting upon achieving certain performance conditions and 8,000,000 shares vesting upon achieving certain additional performance conditions. On May 5, 2021, the Company granted Mr. Broenniman a Non-Statutory Option to acquire 17,662,313 shares of common stock at an exercise price of $0.24 per share with 162,313 shares vesting upon grant of Non-Statutory Option and 17,500,000 shares of common stock underlying the stock options vesting subject to various performance conditions. /s/ Philip R. Broenniman 2021-05-07