Statement of Changes in Beneficial Ownership (4)
April 06 2022 - 7:26PM
Edgar (US Regulatory)
FORM 4
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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
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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
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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)
4/5/2022 |
(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 | 4/5/2022 | | M | | 3948 | A | $16.21 | 234611 | D | |
Common Stock | 4/5/2022 | | S(1) | | 2355 | D | $109.453 (2) | 232256 | D | |
Common Stock | 4/5/2022 | | S(1) | | 1300 | D | $110.8592 (3) | 230956 | D | |
Common Stock | 4/5/2022 | | S(1) | | 293 | D | $111.7541 (4) | 230663 | D | |
Common Stock | 4/5/2022 | | S(1) | | 120 | D | $109.4116 (5) | 40195 | I | By Trust (6) |
Common Stock | 4/5/2022 | | S(1) | | 86 | D | $110.7591 (7) | 40109 | I | By Trust (6) |
Common Stock | 4/5/2022 | | S(1) | | 49 | D | $111.7192 (8) | 40060 | I | By Trust (6) |
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 |
Stock Option (Right to Buy) | $16.21 | 4/5/2022 | | M | | | 3948 | (9) | 4/16/2027 | Common Stock | 3948.0 | $0 | 458552 | D | |
Explanation of Responses: |
(1) | The transaction was effected pursuant to a Rule 10b5-1 plan adopted by the Reporting Person. |
(2) | The shares were sold at prices ranging from $109.05 to $110.03. The Reporting Person will provide upon request to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price. |
(3) | The shares were sold at prices ranging from $110.46 to $111.32. The Reporting Person will provide upon request to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price. |
(4) | The shares were sold at prices ranging from $111.58 to $112.08. The Reporting Person will provide upon request to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price. |
(5) | The shares were sold at prices ranging from $109.10 to $109.86. The Reporting Person will provide upon request to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price. |
(6) | These securities are held by The SVO Family Trust, of which the Reporting Person's spouse is trustee. |
(7) | The shares were sold at prices ranging from $110.19 to $111.17. The Reporting Person will provide upon request to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price. |
(8) | The shares were sold at prices ranging from $111.56 to $111.88. The Reporting Person will provide upon request to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price. |
(9) | This stock option was fully vested on the transaction date. |
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/ Lisa Yun, Attorney-in-fact | | 4/6/2022 |
**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 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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