Statement of Changes in Beneficial Ownership (4)
September 17 2020 - 7:38PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
OLRICH SCOTT V. |
2. Issuer Name and Ticker or Trading Symbol
DOCUSIGN, INC.
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DOCU
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Operating Officer |
(Last)
(First)
(Middle)
C/O DOCUSIGN, INC., 221 MAIN STREET, SUITE 1550 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/15/2020 |
(Street)
SAN FRANCISCO, CA 94105
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 9/15/2020 | | M | | 29539 | A | $0 | 281201 | D | |
Common Stock | 9/15/2020 | | F | | 14647 (1) | D | $0 | 266554 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Restricted Stock Units | (2) | 9/15/2020 | | M | | | 3071 | (3) | (4) | Common Stock | 3071.0 | $0 | 33784 | D | |
Restricted Stock Units | (2) | 9/15/2020 | | M | | | 1468 | (5) | (4) | Common Stock | 1468.0 | $0 | 22027 | D | |
Restricted Stock Units | (2) | 9/15/2020 | | M | | | 25000 | (6) | (4) | Common Stock | 25000.0 | $0 | 75000 | D | |
Explanation of Responses: |
(1) | Represents shares withheld by the Issuer to satisfy a tax obligation realized by the Reporting Person upon the vesting and settlement of restricted stock units. |
(2) | Each restricted stock unit ("RSU") represents a contingent right to receive one share of the Issuer's common stock. |
(3) | The RSUs will vest in sixteen equal quarterly installments over four years, with a vesting commencement date of May 10, 2019, in each case subject to the Reporting Person being a service provider through each such date. The RSUs are subject to accelerated vesting in the event of a termination of employment of the Reporting Person including under certain circumstances following a change in control of the Issuer. |
(4) | The RSUs do not expire; they either vest or are canceled prior to vesting date. |
(5) | The RSUs will vest in sixteen equal quarterly installments over four years, with a vesting commencement date of June 10, 2020, in each case subject to the Reporting Person being a service provider through such date.The restricted stock units are subject to accelerated vesting in the event of a termination of employment of the Reporting Person including under certain circumstances following achange in control of the Issuer. |
(6) | Twenty-five percent of the total RSUs granted vested on April 10, 2018, and the balance of the RSUs shall vest in twelve equal quarterly installments until fully vested on April 10, 2021, in each case subject to the Reporting Person being a service provider through each such date. The RSUs are subject to accelerated vesting in the event of a termination of employment of the Reporting Person including under certain circumstances following a change in control of the Issuer. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
OLRICH SCOTT V. C/O DOCUSIGN, INC. 221 MAIN STREET, SUITE 1550 SAN FRANCISCO, CA 94105 |
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| Chief Operating Officer |
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Signatures
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/s/ Poonam Singh, Attorney-in-fact | | 9/17/2020 |
**Signature of Reporting Person | Date |
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