4//SEC Filing
Chan Heng Fai Ambrose 4
Accession 0001493152-21-015139
CIK 0000771999other
Filed
Jun 22, 8:00 PM ET
Accepted
Jun 23, 9:41 PM ET
Size
10.4 KB
Accession
0001493152-21-015139
Insider Transaction Report
Form 4
Global BioMedical Pte. Ltd.
10% Owner
Transactions
- Conversion
Common Stock
2021-06-21+1,120,170→ 10,036,164 total(indirect: See footnote) - Conversion
Series A Convertible Preferred Stock
2021-06-21−7,259→ 0 total(indirect: See footnote)→ Common Stock (1,120,170 underlying)
Chan Heng Fai Ambrose
Director10% Owner
Transactions
- Conversion
Common Stock
2021-06-21+1,120,170→ 10,036,164 total(indirect: See footnote) - Conversion
Series A Convertible Preferred Stock
2021-06-21−7,259→ 0 total(indirect: See footnote)→ Common Stock (1,120,170 underlying)
Footnotes (4)
- [F1]Global BioMedical Pte. Ltd. ("GBM") has converted 7,259 shares of Series A Convertible Preferred Stock into 1,120,170 shares of the common stock, par value $0.02 per share (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. Following the conversion of 7,259 shares of Series A Convertible Preferred Stock, GBM does not own any shares of Series A Convertible Preferred Stock. Mr. Chan has dispositive control over the securities owned by GBM.
- [F3]The beneficial ownership of the Reporting Person includes 10,036,164 shares of Common Stock, consisting of (a) 1,614,552 shares of Common Stock held by Heng Fai Holdings Limited; (b) 16,667 shares of Common Stock held by BMI Capital Partners International Limited; (c) 474,060 shares of Common Stock held by the Reporting Person; (d) 214,881 shares of Common Stock held by LiquidValue Development Pte Ltd.; and (e) 7,716,004 shares of Common Stock held by Global Biomedical Pte. Ltd.
- [F4]These securities were owned directly by GBM. Mr. Chan has dispositive control over the securities 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
- Jun 22, 8:00 PM ET
- Accepted
- Jun 23, 9:41 PM ET
- Size
- 10.4 KB