0001615774-17-007480.txt : 20171220
0001615774-17-007480.hdr.sgml : 20171220
20171220163555
ACCESSION NUMBER: 0001615774-17-007480
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171219
FILED AS OF DATE: 20171220
DATE AS OF CHANGE: 20171220
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: 171267117
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
s108497_4.xml
4
X0306
4
2017-12-19
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
2017-12-19
4
P
0
2000000
0.13
A
15495890
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.
/s/Theodore Stern
2017-12-20