Statement of Changes in Beneficial Ownership (4)
February 10 2023 - 05:53PM
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 * Roy
Rahul K |
2. Issuer Name and Ticker or Trading
Symbol ARC DOCUMENT SOLUTIONS, INC. [ ARC ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chief Technology Officer |
|
(Last)
(First)
(Middle)
C/O ARC DOCUMENT SOLUTIONS, INC., 12657 ALCOSTA BLVD.,
SUITE 200 |
3. Date of Earliest Transaction (MM/DD/YYYY)
2/8/2023
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|
(Street)
SAN RAMON, CA 94583
(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 |
2/8/2023 |
|
A |
|
35000 (1) |
A |
$0 |
419100 |
D |
|
|
Common Stock |
2/9/2023 |
|
F |
|
4758 (2) |
D |
$0 |
414342 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
|
Employee Stock Option (right to
buy) |
$3.69 |
2/8/2023 |
|
A |
|
65000 |
|
2/8/2024 (3) |
2/8/2033 |
Common Stock |
65000.0 |
$0 |
65000 |
D |
|
| Explanation of
Responses: |
| (1) |
Grant of restricted stock
which vests 33.3% on each of the first three anniversaries of the
grant date. |
| (2) |
These shares were withheld
by the Issuer as payment for the tax liability associated with the
vesting of shares of restricted stock on February 9, 2023 that had
previously been granted to the Reporting Person. |
| (3) |
This stock option vests
33.3% on each of the first three anniversaries of the grant
date. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Roy Rahul K
C/O ARC DOCUMENT SOLUTIONS, INC.
12657 ALCOSTA BLVD., SUITE 200
SAN RAMON, CA 94583 |
|
|
Chief Technology Officer |
|
Signatures
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|
/s/ Jorge Avalos Attorney-in-Fact |
|
2/10/2023 |
| **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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