0001213900-21-025153.txt : 20210507 0001213900-21-025153.hdr.sgml : 20210507 20210507164240 ACCESSION NUMBER: 0001213900-21-025153 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: STERN THEODORE CENTRAL INDEX KEY: 0000935991 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-54545 FILM NUMBER: 21903512 MAIL ADDRESS: STREET 1: EXECUTIVE ASSOCIATES STREET 2: ONE PPG PLACE, SUITE 2970 CITY: PITTSBURGH STATE: PA ZIP: 15222 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 0000935991 STERN THEODORE 220 N. BELLEFIELD AVE., UNIT 1101 PITTSBURGH, PA 15213 1 0 0 0 Common Stock, $0.0001 par value per share 5885445 D Stock Options 0.24 2021-05-05 4 A 0 1645521 0 A 2021-05-05 2031-05-05 Common Stock, $0.0001 par value per share 1645521 1645521 D Common Stock Purchase Warrant 0.15 2020-06-30 2022-06-30 Common Stock, $0.0001 par value per share 250000 250000 D Amended and Restated Promissory Notes 0.20 2020-02-14 2022-02-28 Common Stock, $0.0001 par value per share 15000000 15000000 I See footnote 15% Convertible Note 0.20 2020-02-14 2022-02-28 Common Stock, $0.0001 par value per share 375000 375000 D Interest Shares 0.20 2017-01-31 Common Stock, $0.0001 par value per share 3310000 3310000 I See Footnote Represents 15,000,000 shares of common stock that may be issued upon the conversion of principal at $0.20 per share under that certain Amended & Restated Secured Promissory Note in the principal amount as of the date hereof $2,000,000 issued to the Theodore Stern Revocable Trust (the "Trust"). Represents 3,310,000 shares of common stock that may be issued upon the conversion of interest accrued at $0.20 per share under that certain Unsecured Promissory Note in the principal amount as of the date hereof $2,000,000 issued to the Trust. On May 5, 2021, the Company granted Mr. Stern a Non-Statutory Option to acquire 1,645,521 shares of common stock at an exercise price of $0.24 per share with 973,880 shares vesting upon grant of Non-Statutory Option and 671,641 shares of common stock underlying the stock options vesting over twelve months. /s/ Theodore Stern 2021-05-07