Statement of Changes in Beneficial Ownership (4)
16 September 2021 - 6:24AM
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)
9/14/2021 |
(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 | 9/14/2021 | | M | | 12500 | A | $16.21 | 234322 | D | |
Common Stock | 9/14/2021 | | S(1) | | 2658 | D | $267.7401 (2) | 231664 | D | |
Common Stock | 9/14/2021 | | S(1) | | 2404 | D | $268.9717 (3) | 229260 | D | |
Common Stock | 9/14/2021 | | S(1) | | 2400 | D | $269.9525 (4) | 226860 | D | |
Common Stock | 9/14/2021 | | S(1) | | 2824 | D | $270.9222 (5) | 224036 | D | |
Common Stock | 9/14/2021 | | S(1) | | 2214 | D | $271.7533 (6) | 221822 | D | |
Common Stock | 9/14/2021 | | S(1) | | 189 | D | $267.7801 (7) | 45971 | I | By Trust (8) |
Common Stock | 9/14/2021 | | S(1) | | 174 | D | $269.138 (9) | 45797 | I | By Trust (8) |
Common Stock | 9/14/2021 | | S(1) | | 157 | D | $270.1947 (10) | 45640 | I | By Trust (8) |
Common Stock | 9/14/2021 | | S(1) | | 220 | D | $271.2918 (11) | 45420 | I | By Trust (8) |
Common Stock | 9/14/2021 | | S(1) | | 95 | D | $272.0767 (12) | 45325 | I | By Trust (8) |
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 | 9/14/2021 | | M | | | 12500 | (13) | 4/16/2027 | Common Stock | 12500.0 | $0 | 537500 | 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 $267.36 to $268.25. 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 $268.38 to $269.35. 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 $269.42 to $270.37. 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 $270.44 to $271.42. 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) | The shares were sold at prices ranging from $271.44 to $272.39. 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. |
(7) | The shares were sold at prices ranging from $267.49 to $268.27. 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) | These securities are held by The SVO Family Trust, of which the Reporting Person's spouse is trustee. |
(9) | The shares were sold at prices ranging from $268.62 to $269.48. 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. |
(10) | The shares were sold at prices ranging from $269.74 to $270.58. 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. |
(11) | The shares were sold at prices ranging from $270.80 to $271.73. 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. |
(12) | The shares were sold at prices ranging from $271.82 to $272.34. 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. |
(13) | 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/ Brian Kelly, Attorney-in-fact | | 9/15/2021 |
**Signature of Reporting Person | Date |
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