Statement of Changes in Beneficial Ownership (4)
March 17 2022 - 05:00PM
Edgar (US Regulatory)
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FORM 4
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
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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 * Phi
Tram T |
2. Issuer Name and Ticker or Trading
Symbol DOCUSIGN, INC. [ DOCU ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
SVP, General Counsel |
|
(Last)
(First)
(Middle)
C/O DOCUSIGN, INC., 221 MAIN STREET, SUITE 1550 |
3. Date of Earliest Transaction (MM/DD/YYYY)
3/15/2022
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|
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
|
Code |
V |
Amount |
(A) or (D) |
Price |
|
Common Stock |
3/15/2022 |
|
M |
|
5181 |
A |
$0 |
9336 |
D |
|
|
Common Stock |
3/15/2022 |
|
F |
|
1851 (1) |
D |
$73.24 |
7485 |
D |
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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) |
3/15/2022 |
|
M |
|
|
3683 |
(3) |
(4) |
Common Stock |
3683.0 |
$0 |
22098 |
D |
|
|
Restricted Stock Units |
(2) |
3/15/2022 |
|
M |
|
|
734 |
(5) |
(4) |
Common Stock |
734.0 |
$0 |
6609 |
D |
|
|
Restricted Stock Units |
(2) |
3/15/2022 |
|
M |
|
|
764 |
(6) |
(4) |
Common Stock |
764.0 |
$0 |
9928 |
D |
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| 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
("RSU"). |
| (2) |
Each RSU represents a
contingent right to receive one share of common stock of the Issuer
upon vesting. |
| (3) |
Twenty-five percent of the
total RSUs granted vested on July 10, 2020, and the balance of the
RSUs shall vest in twelve equal quarterly installments until fully
vested on July 20, 2023, 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 May 10, 2020, 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. |
| (6) |
The RSUs will vest in equal
quarterly installments over four years, with a vesting commencement
date of May 10, 2021, in each case subject to the Reporting Person
being a service provider through each 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 a change in control of the
Issuer. |
Reporting
Owners
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|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Phi Tram T
C/O DOCUSIGN, INC.
221 MAIN STREET, SUITE 1550
SAN FRANCISCO, CA 94105 |
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|
SVP, General Counsel |
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Signatures
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/s/ Brian Kelly, Attorney-in-fact |
|
3/17/2022 |
| **Signature of
Reporting Person |
Date |
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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 4(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. |
|
Persons who respond to the collection of information
contained in this form are not required to respond unless the form
displays a currently valid OMB control number. |
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