0001213900-21-057713.txt : 20211109 0001213900-21-057713.hdr.sgml : 20211109 20211109160546 ACCESSION NUMBER: 0001213900-21-057713 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211105 FILED AS OF DATE: 20211109 DATE AS OF CHANGE: 20211109 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: 001-40747 FILM NUMBER: 211392062 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 2021-11-05 0 0001534154 Ipsidy Inc. AUID 0001781770 Broenniman Philip R C/O IPSIDY INC., 670 LONG BEACH BLVD. LONG BEACH, NY 11561 1 0 0 0 Common Stock, $.0001 par value 172747 D Common Stock, $.0001 par value 340832 I See footnote Stock Options 7.20 2021-11-05 4 D 0 200000 D 2021-05-05 2031-05-05 Common Stock, $0.0001 par value per share 388744 388744 D Warrants 4.50 2020-06-30 2022-06-30 Common Stock, $0.0001 par value per share 30972 30972 I See Footnotes Stock Options 2.10 2020-05-22 2025-05-22 Common Stock, $0.0001 par value per share 555556 555556 D Warrants 4.95 2018-08-15 2023-08-15 Common Stock, $0.0001 par value per share 11667 11667 D Warrants 2.64 2019-06-24 2024-06-23 Common Stock, $0.0001 par value per share 8750 8750 D Includes the right to acquire 50,000 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 November 5, 2021, the Company and Mr. Broenniman entered into a letter agreement pursuant to which Mr. Broenniman agreed to cancel 200,000 shares of common stock under the Non-Statutory Option dated May 5, 2021 in consideration of removing certain service conditions. /s/ Philip R. Broenniman 2021-11-09