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