4//SEC Filing
Chan Heng Fai Ambrose 4
Accession 0001493152-21-013109
CIK 0000771999other
Filed
May 26, 8:00 PM ET
Accepted
May 27, 8:03 PM ET
Size
10.1 KB
Accession
0001493152-21-013109
Insider Transaction Report
Form 4
Global BioMedical Pte. Ltd.
10% Owner
Transactions
- Conversion
Series A Convertible Preferred Stock
2021-05-26−35,316→ 7,259 total(indirect: See footnote)→ Common Stock (5,450,000 underlying) - Conversion
Common Stock
2021-05-26+5,450,000→ 6,595,834 total(indirect: See footnote)
Chan Heng Fai Ambrose
Director10% Owner
Transactions
- Conversion
Common Stock
2021-05-26+5,450,000→ 6,595,834 total(indirect: See footnote) - Conversion
Series A Convertible Preferred Stock
2021-05-26−35,316→ 7,259 total(indirect: See footnote)→ Common Stock (5,450,000 underlying)
Footnotes (3)
- [F1]Global BioMedical Pte. Ltd. ("GBM") has converted 35,316 shares of Series A Convertible Preferred Stock into 5,450,000 shares of the common stock of Document Security Systems, Inc. (the "Issuer").
- [F2]The Series A Convertible Preferred Stock of the Issuer has a stated value of $1,000 per share and may be converted into shares of the common stock of the Issuer at a conversion price of $6.48 per share, subject to a 19.99% beneficial ownership conversion limitation (the "Blocker") based on the total issued and outstanding shares of common stock of the Issuer beneficially owned by GBM. There are currently 33,120,125 shares of the Issuer's common stock issued and outstanding, and therefore, as a result of the Blocker, GBM is currently able to convert an additional 201 shares of Series A Preferred Stock, equal to 31,018 shares of the Issuer's common stock. Mr. Chan has dispositive control over the securities owned by GBM.
- [F3]These securities are owned directly by GBM. Mr. Chan has dispositive control over the common stock and Series A Convertible Preferred Stock of the Issuer owned by GBM.
Documents
Issuer
DOCUMENT SECURITY SYSTEMS INC
CIK 0000771999
Entity typeother
Related Parties
1- filerCIK 0001261725
Filing Metadata
- Form type
- 4
- Filed
- May 26, 8:00 PM ET
- Accepted
- May 27, 8:03 PM ET
- Size
- 10.1 KB