Statement of Changes in Beneficial Ownership (4)
June 16 2021 - 5:35PM
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
|
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
|
1. Name and Address of Reporting Person
*
Salem Enrique T |
2. Issuer Name and Ticker or Trading Symbol
DOCUSIGN, INC.
[
DOCU
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
|
|
(Last)
(First)
(Middle)
C/O BAIN CAPITAL VENTURE INVESTORS, LLC, 200 CLARENDON STREET |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/14/2021 |
|
(Street)
BOSTON, MA 02116
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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 | 6/14/2021 | | J(3) | | 625036 | D | $0.00 | 699964 | I | See footnotes (1)(2) |
| Common Stock | | | | | | | | 149620 (4) | D | |
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 |
| Explanation of Responses: |
| (1) | Represents shares of Common Stock held directly by BCIP Venture Associates ("BCIP Venture"), BCIP Venture Associates-B ("BCIP Venture-B"), BCIP Venture Associates II, L.P. ("BCIP Venture II"), BCIP Venture Associates II-B, L.P. ("BCIP Venture II-B"), Bain Capital Venture Fund 2014, L.P. ("BCV Fund 2014"), Bain Capital Venture Partners 2014, L.P. ("BCV Partners 2014"), Bain Capital Venture Coinvestment Fund, L.P. ("BCV Coinvestment Fund") and Bain Capital Venture Coinvestment Partners, L.P. ("BCV Coinvestment Partners" and, collectively, the "Bain Capital Venture Entities"). |
| (2) | Bain Capital Venture Investors, LLC ("BCVI") is (i) the general partner of each of BCV Partners 2014, which is the general partner of BCV Fund 2014, and BCV Coinvestment Partners, which is the general partner of BCV Coinvestment Fund and (ii) governs the investment strategy and decision-making process with respect to investments held by each of BCIP Venture, BCIP Venture-B, BCIP Venture II and BCIP Venture II-B. Mr. Salem is a member of the Executive Committee and a Managing Director of BCVI. By virtue of the relationships described in this footnote, Mr. Salem may be deemed to share voting and dispositive power with respect to all of the shares of Common Stock held by the Bain Capital Venture Entities. Mr. Salem disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein. |
| (3) | On June 14, 2021, certain of the Bain Capital Venture Entities distributed an aggregate of 625,036 shares of Common Stock to one or more partners in pro-rata in-kind distributions without consideration, including an aggregate of 12,453 shares of Common Stock that were distributed to Mr. Salem. |
| (4) | Includes 12,453 shares of Common Stock received in the distributions referred to in footnote (3) above. |
Reporting Owners
|
| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Salem Enrique T
C/O BAIN CAPITAL VENTURE INVESTORS, LLC
200 CLARENDON STREET
BOSTON, MA 02116 | X |
|
|
|
Signatures
|
| /s/ Enrique T. Salem | | 6/16/2021 |
| **Signature of Reporting Person | Date |
DocuSign (NASDAQ:DOCU)
Historical Stock Chart
From Mar 2024 to Apr 2024
DocuSign (NASDAQ:DOCU)
Historical Stock Chart
From Apr 2023 to Apr 2024
