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