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