0001213900-21-045475.txt : 20210830 0001213900-21-045475.hdr.sgml : 20210830 20210830080103 ACCESSION NUMBER: 0001213900-21-045475 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210826 FILED AS OF DATE: 20210830 DATE AS OF CHANGE: 20210830 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Broenniman Philip R CENTRAL INDEX KEY: 0001781770 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40747 FILM NUMBER: 211221027 MAIL ADDRESS: STREET 1: C/O CSS INDUSTRIES, INC. STREET 2: 450 PLYMOUTH ROAD, SUITE 300 CITY: PLYMOUTH MEETING STATE: PA ZIP: 19462 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: 670 LONG BEACH BLVD. CITY: LONG BEACH STATE: NY ZIP: 11561 BUSINESS PHONE: 516-274-8700 MAIL ADDRESS: STREET 1: 670 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 ownership.xml X0306 4 2021-08-26 0 0001534154 Ipsidy Inc. AUID 0001781770 Broenniman Philip R C/O IPSIDY INC. 670 LONG BEACH BLVD. LONG BEACH NY 11561 1 0 0 0 Common Stock, $.0001 par value 172747 D Common Stock, $.0001 par value 2021-08-26 4 P 0 35700 7.00 A 340832 I See footnote Stock Options 7.20 2021-05-05 2031-05-05 Common Stock, $0.0001 par value per share 588744 588744 D Warrants 4.50 2020-06-30 2022-06-30 Common Stock, $0.0001 par value per share 30972 30972 I See Footnotes Stock Options 2.10 2020-05-22 2025-05-22 Common Stock, $0.0001 par value per share 555556 555556 D Warrants 4.95 2018-08-15 2023-08-15 Common Stock, $0.0001 par value per share 11667 11667 D Warrants 2.64 2019-06-24 2024-06-23 Common Stock, $0.0001 par value per share 8750 8750 D Includes the right to acquire 50,000 shares of common stock at par value subject to the certain vesting criteria granted to Mr. Broenniman on March 6, 2020 pursuant to a Restricted Stock Purchase Agreement. Mr. Broenniman is the Managing Partner of Varana Capital, LLC ("Varana Capital"), which, in turn, is the investment manager of and has dispositive control over the shares held by Varana Capital Focused, LP ("VCFLP"). By virtue of these relationships, in addition to the shares he holds personally, Mr. Broenniman may be deemed to beneficially own the shares held by Varana Capital Focused, LP. On May 5, 2021, the Company granted Mr. Broenniman a Non-Statutory Option to acquire 588,744 shares of common stock at an exercise price of $7.20 per share with 5,410 shares vesting upon grant of Non-Statutory Option and 583,333 shares of common stock underlying the stock options vesting subject to various performance conditions. /s/ Philip R. Broenniman 2021-08-27