SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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1. Name and Address of Reporting Person*
Garchik Stephen Jeffrey

(Last) (First) (Middle)
2474 SOUTH OCEAN BOULEVARD

(Street)
HIGHLAND BEACH FL 33487

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/18/2022
3. Issuer Name and Ticker or Trading Symbol
Ipsidy Inc. [ AUID ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
Director by Deputization
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 2,002,003 D
Common Stock 166,667 I See Footnotes(1)(2)
Common Stock 11,667 I See Footnotes(1)(3)
Common Stock 89,306 I(2) See Footnotes(1)(4)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Common Stock Purchase Warrant 11/06/2020 11/06/2025 Common Stock 83,334 4.5 I See footnotes(1)(5)
Common Stock Purchase Warrant 06/30/2020 06/30/2022 Common Stock 40,660 4.5 I See footnotes(1)(6)
Convertible Notes 03/21/2022 03/21/2025 Common Stock 270,271 3.7 D
Explanation of Responses:
1. Stephen J. Garchik ("Mr. Garchik") disclaims beneficial ownership of any and all of the Issuer's securities reported herein in excess of its actual pecuniary interest.
2. Held by the Garchik Irrevocable 2019 Trust (the "2019 Trust") of which Mr. Garchik is a trustee
3. Held by Garchik Universal Limited Partnership, which Mr. Garchik jointly controls with his sister.
4. Held by Marla Garchik Irrevocable 2020 Trust (the "2020 Trust") of which Mr. Garchik is a beneficiary.
5. Held by the 2019 Trust.
6. Held by the 2020 Trust.
Remarks:
Mr. Garchik may be deemed to be a director by deputization for purposes of Section 16 under the Securities Exchange Act of 1934 by virtue of the fact that pursuant to a Facility Agreement (the "Facility Agreement") entered into between the Issuer and Mr. Garchik, Mr. Garchik is entitled to nominate one designee to the Issuer's board of directors until such time as all amounts due pursuant to the Facility Agreement are repaid in full.
/s/ Stephen J. Garchik 04/28/2022
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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