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