0001213900-22-014524.txt : 20220323 0001213900-22-014524.hdr.sgml : 20220323 20220323170025 ACCESSION NUMBER: 0001213900-22-014524 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220321 FILED AS OF DATE: 20220323 DATE AS OF CHANGE: 20220323 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: 22763774 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 2022-03-21 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 2022-03-21 4 A 0 311 3.22 A 173058 D Common Stock, $.0001 par value 2022-03-21 4 A 0 3106 3.22 A 343938 I See footnote Senior Secured Convertible Note 3.70 2022-03-21 4 A 0 270270 1000000 A 2022-03-21 2025-03-21 Common Stock, $0.0001 par value per share 270270 270270 I See Footnotes Senior Secured Convertible Note 3.70 2022-03-21 4 A 0 27027 100000 A 2022-03-21 2025-03-21 Common Stock, $0.0001 par value per share 27027 27027 D Stock Options 15.16 2021-12-29 2031-12-29 Common Stock, $0.0001 par value per share 10238 10238 D Stock Options 7.20 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 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. The shares vest monthly in equal amounts over a one-year period. 383,334 of the shares vest upon meeting performance criteria. Upon acquiring the Senior Secured Convertible Note, the reporting person was issued an origination fee in shares of common stock equal to 1.0% of the original principal amount of the reporting person's Senior Secured Convertible Notes with the value of each such share being the arithmetic average of the volume weighted average price of the Common Stock for each of the ten trading days immediately preceding the effective date. /s/ Philip R. Broenniman 2022-03-23