Statement of Changes in Beneficial Ownership (4)
February 11 2022 - 05:57PM
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
|
|
1. Name
and Address of Reporting Person *
Wijesuriya Dilantha |
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 Operating Officer |
(Last)
(First)
(Middle)
C/O ARC DOCUMENT SOLUTIONS, INC., 12657 ALCOSTA BLVD.,
SUITE 200 |
3. Date of Earliest Transaction (MM/DD/YYYY)
2/9/2022
|
(Street)
SAN RAMON, CA 94583
(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 |
2/9/2022 |
|
A |
|
35000 (1) |
A |
$0 |
440301 |
D |
|
Common Stock |
|
|
|
|
|
|
|
328450 |
I |
Wijesuriya Family Trust DTD
9/4/2002 |
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 |
Option (right to buy) |
$3.21 |
2/9/2022 |
|
A |
|
165000 |
|
2/9/2023 (2) |
2/9/2032 |
Common Stock |
165000.0 |
$0 |
165000 |
D |
|
Option (right to buy) |
$3.21 |
2/9/2022 |
|
A |
|
86465 |
|
2/9/2023 (3) |
2/9/2032 |
Common Stock |
86465.0 |
$0 |
86465 |
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) |
This stock option vests
33.3% on each of the first three anniversaries of the grant
date. |
(3) |
This stock option vests 25%
on each of the first four anniversaries of the grant
date. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Wijesuriya Dilantha
C/O ARC DOCUMENT SOLUTIONS, INC.
12657 ALCOSTA BLVD., SUITE 200
SAN RAMON, CA 94583 |
|
|
Chief Operating Officer |
|
Signatures
|
/s/ Jorge Avalos,
Attorney-in-Fact |
|
2/11/2022 |
**Signature of
Reporting Person |
Date |
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