SEC Form 4 · accession 0001144204-18-064532
DOCUSIGN, INC. · DOCU
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mary G Meeker
Director
Period of report
Dec 11, 2018
Accepted (ET)
Dec 13, 2018 · 9:30 pm EST
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 |
|---|---|---|---|---|---|---|---|---|
| Class A Common StockF3 | Dec 11, 2018 | J | 306,674 | $0.00 | D | 41,337 | I | See Footnote |
| Class A Common StockF5 | Dec 11, 2018 | J | 35,018 | $0.00 | A | 38,788 | D | |
| Class A Common StockF3 | Dec 13, 2018 | J | 20,668 | $0.00 | D | 20,669 | I | See Footnote |
| Class A Common StockF5 | Dec 13, 2018 | J | 15,442 | $0.00 | A | 54,230 | D | |
| Class A Common StockF1 | holding | — | — | — | 2,288,550 | I | See Footnote |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The reporting person is a managing member of KPCB DGF Associates, LLC ("DGF Associates"), which is the managing member of KPCB Digital Growth Fund, LLC ("KPCB Growth") and KPCB DGF Founders Fund, LLC ("KPCB FF"). KPCB Holdings, Inc., as nominee, holds the stock for the account of KPCB Growth and KPCB FF. The reporting person may be deemed to share voting and investment power over the securities held by KPCB Growth and KPCB FF. The reporting person disclaims beneficial ownership over such securities except to the extent of her pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
- F2Represents a pro-rata in-kind distribution of Class A Common Stock of the Issuer by DGF Associates without consideration to its members (the "DGF Associates Distribution").
- F3The shares are held directly by DGF Associates. The reporting person is a managing member of DGF Associates and may be deemed to share voting and investment power over the securities held by DGF Associates. The reporting person disclaims beneficial ownership over such securities except to the extent of her pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes. The reported number includes 348,011 shares received by DGF Associates as a result of a pro-rata, in-kind distribution by KPCB Growth and KPCB FF on October 23, 2018
- F4Represents a change in the form of ownership from indirect to direct by virtue of the receipt of shares in the DGF Associates Distribution.
- F5Shares are held directly by the reporting person.