0001615774-17-005534.txt : 20171003
0001615774-17-005534.hdr.sgml : 20171003
20171003170135
ACCESSION NUMBER: 0001615774-17-005534
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170928
FILED AS OF DATE: 20171003
DATE AS OF CHANGE: 20171003
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: STERN THEODORE
CENTRAL INDEX KEY: 0000935991
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-54545
FILM NUMBER: 171118873
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
3
1
s107684_form3.xml
3
X0206
3
2017-09-28
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
13495890
D
Common Stock, $0.0001 par value per share
4500000
I
Held by Theodore Stern Revocable Trust, which Mr. Stern serves as trustee
Common Stock Purchase Warrant
0.10
2016-04-19
2021-04-19
Common Stock
1000000
D
Interest Shares
0.20
2017-01-31
2019-01-31
Common Stock
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
2017-10-03