0001615774-17-006418.txt : 20171109 0001615774-17-006418.hdr.sgml : 20171109 20171109170049 ACCESSION NUMBER: 0001615774-17-006418 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171108 FILED AS OF DATE: 20171109 DATE AS OF CHANGE: 20171109 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: 171191703 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: 780 LONG BEACH BLVD. CITY: LONG BEACH STATE: NY ZIP: 11561 BUSINESS PHONE: (407) 951-8640 MAIL ADDRESS: STREET 1: 780 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 s108086_4.xml 4 X0306 4 2017-11-08 0 0001534154 Ipsidy Inc. IDGS 0000935991 STERN THEODORE ONE PPG PLACE SUITE 2970 PITTSBURGH PA 15222 1 0 0 0 Common Stock, $0.0001 par value per share 2017-11-08 4 G 0 4500000 D 0 I See Footnote Common Stock, $0.0001 par value per share 13495890 D Common Stock Purchase Warrant 0.1 2016-04-19 2021-04-19 Common Stock 1000000 1000000 D Interest Shares 0.20 2017-01-31 Common Stock 1400000 1400000 I See Footnote 1,400,000 shares of common stock that may be issued upon the conversion of interest accrued at $0.20 per share as of September 30, 2017 under that certain Unsecured Promissory Note due January 31, 2019 in the principal amount of $3,000,000 issued to the Theodore Stern Revocable Trust. On November 8, 2017, Theodore Stern Revocable Trust assigned 4,500,000 shares of common stock to the Theodore Stern Charitable Lead Annuity Trust, DTD 11/08/2017, C/O Jewish Community Foundation (the "Charitable Trust"). Mr. Stern has no control over the Charitable Trust. /s/Theodore Stern 2017-11-09