SEC Form 4 · accession 0001683168-18-003638
Paysign, Inc. · PAYS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Joan M Herman
Officer — Chief Operating Officer · Director
Period of report
Dec 5, 2018
Accepted (ET)
Dec 7, 2018 · 4:39 pm EST
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 | Dec 5, 2018 | A | 200,000 | — | A | 400,000 | D |
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 | — | Dec 5, 2018 | C | 200,000 | D | — | — | Common Stock | 200,000 | 600,000 | D |
Explanation of responses
- F1N/A
- F2N/A
- F3Upon employment, the Company granted Joan M. Herman 200,000 shares of restricted common stock with a value of $84,400.00. These shares have been issued and are restricted. At the same time, the Company also granted but did not issued Ms. Herman four equal tranches of two hundred thousand restricted shares each, which vest quarterly in equal amounts over a four year period on the last day of each quarter, commencing December 31, 2017, if Joan M. Herman is still employed at that time. As of December 5, 2018, two hundred thousand shares have vested and have been issued. Six hundred thousand shares have not vested, and have not been issued.