SEC Form 4 · accession 0001019687-15-002570
Paysign, Inc. · PAYS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
David Weiler
Director
Period of report
Jun 29, 2015
Accepted (ET)
Jun 30, 2015 · 8:29 am EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001496443
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common stockF1 | Jun 29, 2015 | A | 500,000 | — | A | 3,748,800 | D | |
| Common stock | holding | — | — | — | 147,050 | I | By Spouse |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock GrantF3,F2 | — | Jun 29, 2015 | C | 500,000 | D | — | — | Common stock | 500,000 | 0 | D |
Explanation of responses
- F1Not applicable
- F2Not applicable
- F3On August 13, 2012, the company granted David Weiler one million shares of common stock with a value of $68,000. The stock grant vested in equal amounts over a five year period on the last day of each calendar quarter if Mr. Weiler is still employed by the company at that time. The board of directors waived all vesting requirements relating to the shares, and all unvested shares became fully vested as of December 31, 2014.