0001683168-21-004258.txt : 20210913 0001683168-21-004258.hdr.sgml : 20210913 20210913195623 ACCESSION NUMBER: 0001683168-21-004258 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210909 FILED AS OF DATE: 20210913 DATE AS OF CHANGE: 20210913 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Herman Joan M CENTRAL INDEX KEY: 0001717123 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38623 FILM NUMBER: 211250913 MAIL ADDRESS: STREET 1: 1700 W. HORIZON RIDGE PARKWAY #200 CITY: HENDERSON STATE: NV ZIP: 89012 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Paysign, Inc. CENTRAL INDEX KEY: 0001496443 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 954550154 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2615 ST. ROSE PARKWAY CITY: HENDERSON STATE: NV ZIP: 89052 BUSINESS PHONE: 702-453-2221 MAIL ADDRESS: STREET 1: 2615 ST. ROSE PARKWAY CITY: HENDERSON STATE: NV ZIP: 89052 FORMER COMPANY: FORMER CONFORMED NAME: 3PEA INTERNATIONAL, INC. DATE OF NAME CHANGE: 20100713 4 1 ownership.xml X0306 4 2021-09-09 0 0001496443 Paysign, Inc. PAYS 0001717123 Herman Joan M 2615 ST. ROSE PARKWAY HENDERSON NV 89052 1 1 0 0 EVP, Operations Common Stock 2021-09-09 4 S 0 2943 2.562 D 757668 D On June 29, 2017, the reporting person received a grant of 1,000,000 shares of common stock. 200,000 vested on date of employment (9/4/17). The remaining 800,000 vested annually in equal amounts over a four-year period commencing on September 3, 2018. As of the date of this filing, 1,000,000 shares of common stock have vested and been issued. The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $2.35 to $2.83, inclusive. The reporting person undertakes to provide to Paysign, Inc. (the "Company"), any security holder of the Company, or the staff of the Securities and Exchange Commission (the "SEC"), upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. /s/ Joan M. Herman 2021-09-13