SC 13G 1 a3739903.txt SCHEDULE 13G UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ------------ SCHEDULE 13G (Amendment No. __) UNDER THE SECURITIES EXCHANGE ACT OF 1934 iPayment, Inc. ---------------- (Name of Issuer) Common Stock, par value $0.01 per share --------------------------------------- (Title of Class of Securities) 46262E105 -------------- (CUSIP Number) December 31, 2003 ------------------------------------------------------- (Date of Event Which Required Filing of this Statement) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: [ ] Rule 13d-1(b) [ ] Rule 13d-1(c) [X] Rule 13d-1(d) ------------------- CUSIP No. 46262E105 13G Page 2 of 6 Pages ------------------- -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Gregory S. Daily -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a) [ ] (b) [ ] -------------------------------------------------------------------------------- 3 SEC USE ONLY -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States of America -------------------------------------------------------------------------------- NUMBER OF SHARES 5 SOLE VOTING POWER BENEFICIALLY OWNED BY EACH 1,967,739 REPORTING ------------------------------------------------------------- PERSON WITH 6 SHARED VOTING POWER 0 ------------------------------------------------------------- 7 SOLE DISPOSITIVE POWER 1,967,739 ------------------------------------------------------------- 8 SHARED DISPOSITIVE POWER 0 -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,967,739 -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES [ ] -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 12% -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON IN -------------------------------------------------------------------------------- ------------------- CUSIP No. 46262E105 13G Page 3 of 6 Pages ------------------- Item 1(a). Name of Issuer: iPayment, Inc. Item 1(b). Address of Issuer's Principal Executive Offices: 40 Burton Hills Boulevard, Suite 415, Nashville, Tennessee 37215 Item 2(a). Name of Person Filing: Gregory S. Daily Item 2(b). Address of Principal Business Office or, if none, Residence: The address of the principal business office of Gregory S. Daily is: c/o 40 Burton Hills Boulevard, Suite 415 Nashville, Tennessee 37215 Item 2(c). Citizenship: The citizenship of Gregory S. Daily is the United States of America. Item 2(d). Title of Class of Securities: Common stock, par value $0.01 per share Item 2(e). CUSIP Number: 46262E105 Item 3. If this statement is filed pursuant to Rules 13d-1(b), or 13d-2(b) or (c), check whether the person filing is a: (a) [ ] Broker or dealer registered under section 15 of the Act; (b) [ ] Bank as defined in section 3(a)(6) of the Act; ------------------- CUSIP No. 46262E105 13G Page 4 of 6 Pages ------------------- (c) [ ] Insurance company as defined in section 3(a)(19) of the Act; (d) [ ] Investment company registered under section 8 of the Investment Company Act of 1940; (e) [ ] An investment adviser in accordance with Rule 13d-1(b)(1)(ii)(E); (f) [ ] An employee benefit plan or endowment fund in accordance with Rule 13d-1(b)(1)(ii)(F); (g) [ ] A parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G) (Note: See Item 7); (h) [ ] A savings association as defined in section 3(b) of the Federal Deposit Insurance Act; (i) [ ] A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940; (j) [ ] Group, in accordance with Rule 13d-1(b)(1)(ii)(H). If this statement is filed pursuant to Rule 13d-1(c), check this box. |_| Item 4. Ownership. (a) Amount beneficially owned: See Item 9 of cover page. (b) Percent of class: See Item 11 of cover page. (c) Number of shares as to which the person has: (i) Sole power to vote or to direct the vote: See Item 5 of cover page. (ii) Shared power to vote or to direct the vote: See Item 6 of cover page. (iii) Sole power to dispose or to direct the disposition of: See Item 7 of cover page. (iv) Shared power to dispose or to direct the disposition of: See Item 8 of cover page. ------------------- CUSIP No. 46262E105 13G Page 5 of 6 Pages ------------------- Item 5. Ownership of Five Percent or Less of a Class. Not Applicable. Item 6. Ownership of More than Five Percent on Behalf of Another Person. Not applicable. Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company or Control Person. Not Applicable. Item 8. Identification and Classification of Members of the Group. Not Applicable. Item 9. Notice of Dissolution of Group. Not Applicable. Item 10. Certification. Not Applicable. ------------------- CUSIP No. 46262E105 13G Page 6 of 6 Pages ------------------- SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. Dated: February 13, 2004 By: /s/ Gregory S. Daily ----------------------------------- Name: Gregory S. Daily