SEC Form 4 · accession 0000899243-18-011287

DOCUSIGN, INC. · DOCU

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

May 1, 2018

Accepted (ET)

May 3, 2018 · 4:12 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001261333

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2,F3	May 1, 2018	M	18,498	—	A	18,498	I	See footnotes
Common Stock^F1,F2,F3	May 1, 2018	M	5,541	—	A	24,039	I	See footnotes
Common Stock^F1,F2,F3	May 1, 2018	M	1,916,890	—	A	1,940,929	I	See footnotes
Common Stock^F1,F2,F3	May 1, 2018	M	343,417	—	A	2,284,346	I	See footnotes
Common Stock^F1,F2,F3	May 1, 2018	M	3,011,559	—	A	5,295,905	I	See footnotes
Common Stock^F1,F4	May 1, 2018	M	89,811	—	A	89,811	I	See footnote
Common Stock	holding	—	—		—	57,111	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Redeemable Convertible Series B Preferred Stock^F1,F2,F3	—	May 1, 2018	M	18,498	D	—	—	Common Stock	18,498	I
Redeemable Convertible Series B-1 Preferred Stock^F1,F2,F3	—	May 1, 2018	M	5,541	D	—	—	Common Stock	5,541	I
Redeemable Convertible Series D Preferred Stock^F1,F2,F3	—	May 1, 2018	M	1,916,890	D	—	—	Common Stock	1,916,890	I
Redeemable Convertible Series E Preferred Stock^F1,F2,F3	—	May 1, 2018	M	343,417	D	—	—	Common Stock	343,417	I
Redeemable Convertible Series F Preferred Stock^F1,F2,F3	—	May 1, 2018	M	3,011,559	D	—	—	Common Stock	3,011,559	I
Redeemable Convertible Series D Preferred Stock^F1,F4	—	May 1, 2018	M	89,811	D	—	—	Common Stock	89,811	I

F1These shares of redeemable convertible preferred stock automatically converted into shares of Common Stock on a 1-for-1 basis immediately upon the closing of the Issuer's initial public offering. These shares of redeemable convertible preferred stock had no expiration date.
F2Represents securities of the Issuer held directly by Bain Capital Venture Fund 2012, L.P., Bain Capital Venture Fund 2014, L.P., Bain Capital Venture Coinvestment Fund, L.P., BCIP Venture Associates, BCIP Venture Associates-B, BCIP Venture Associates II, LP and BCIP Venture Associates II-B, LP, (collectively, the "Bain Venture Entities").
F3The governance, investment strategy and decision-making process with respect to the investments held by the Bain Venture Entities is directed by the Executive Committee of Bain Capital Venture Investors, LLC ("BCVI"). Mr. Salem is 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 Issuer's securities held by the Bain Venture Entities. Mr. Salem disclaims beneficial ownership except to the extent of his pecuniary interest therein.
F4Represents securities of the Issuer held directly by NPI Capital, LLC. Mr. Salem is the managing member of NPI Capital, LLC.