SEC Form 4 · accession 0001209191-18-027182

DOCUSIGN, INC. · DOCU

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

Reporting owner

Scott C Darling

Director

Period of report

May 1, 2018

Accepted (ET)

May 1, 2018 · 6:16 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	May 1, 2018	C	1,987,319	—	A	2,053,078	I	See footnote
Common Stock^F3,F2	May 1, 2018	C	948,167	—	A	3,001,245	I	See footnote
Common Stock^F3,F2	May 1, 2018	C	4,729,005	—	A	7,730,250	I	See footnote
Common Stock^F3,F2	May 1, 2018	C	855,646	—	A	8,585,896	I	See footnote
Common Stock^F3,F2	May 1, 2018	C	942,427	—	A	9,528,323	I	See footnote
Common Stock^F3,F2	May 1, 2018	C	170,295	—	A	9,698,618	I	See footnote
Common Stock^F2	May 1, 2018	S	495,547	$29.00	D	9,203,071	I	See footnote

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series A Preferred Stock^F4,F1	—	May 1, 2018	C	1,944,674	D	—	—	Common Stock	1,987,319	I
Series A-1 Preferred Stock^F4,F3	—	May 1, 2018	C	948,167	D	—	—	Common Stock	948,167	I
Series B Preferred Stock^F4,F3	—	May 1, 2018	C	4,729,005	D	—	—	Common Stock	4,729,005	I
Series B-1 Preferred Stock^F4,F3	—	May 1, 2018	C	855,646	D	—	—	Common Stock	855,646	I
Series C Preferred Stock^F4,F3	—	May 1, 2018	C	942,427	D	—	—	Common Stock	942,427	I
Series D Preferred Stock^F4,F3	—	May 1, 2018	C	170,295	D	—	—	Common Stock	170,295	I

Explanation of responses

F1Each share of Series A Preferred Stock converted into 1.02192925205 shares of common stock upon the closing of the Issuer's initial public offering. The shares had no expiration date.
F2The shares are owned directly by Frazier Technology Ventures II, L.P. ("Frazier"). Frazier's sole general partner is FTVM II, L.P. ("FTVM II") and FTVM II's sole general partner is Frazier Technology Management, L.L.C. ("Frazier Tech Management"). Scott Darling is a managing member of Frazier Tech Management. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
F3Each share of Series A-1 Preferred Stock, Series B Preferred Stock, Series B-1 Preferred Stock, Series C Preferred Stock and Series D Preferred Stock converted into one share of common stock upon the closing of the Issuer's initial public offering. The shares had no expiration date.
F4The shares were held by Frazier. Frazier's sole general partner is FTVM II and FTVM II's sole general partner is Frazier Tech Management. Scott Darling is a managing member of Frazier Tech Management. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.