0001209191-18-027188.txt : 20180501
0001209191-18-027188.hdr.sgml : 20180501
20180501182930
ACCESSION NUMBER: 0001209191-18-027188
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180501
FILED AS OF DATE: 20180501
DATE AS OF CHANGE: 20180501
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Roberts Jonathan David
CENTRAL INDEX KEY: 0001736120
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38465
FILM NUMBER: 18796917
MAIL ADDRESS:
STREET 1: C/O DOCUSIGN, INC., 221 MAIN ST.
STREET 2: SUITE 1000
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: DOCUSIGN INC
CENTRAL INDEX KEY: 0001261333
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 912183967
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0131
BUSINESS ADDRESS:
STREET 1: 221 MAIN ST., SUITE 1000
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
BUSINESS PHONE: 866-219-4318
MAIL ADDRESS:
STREET 1: 221 MAIN ST., SUITE 1000
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-05-01
0
0001261333
DOCUSIGN INC
DOCU
0001736120
Roberts Jonathan David
C/O IGNITION PARTNERS
350 106TH AVE. NE, 1ST FLOOR
BELLEVUE
WA
98004
1
0
0
0
Common Stock
2018-05-01
4
C
0
2658418
A
2764846
I
See footnote
Common Stock
2018-05-01
4
C
0
1264222
A
4029068
I
See footnote
Common Stock
2018-05-01
4
C
0
8546742
A
12575810
I
See footnote
Common Stock
2018-05-01
4
C
0
1392050
A
13967860
I
See footnote
Common Stock
2018-05-01
4
C
0
1533237
A
15501097
I
See footnote
Common Stock
2018-05-01
4
C
0
195759
A
15696856
I
See footnote
Common Stock
2018-05-01
4
S
0
784843
29.00
D
14912013
I
See footnote
Series A Preferred Stock
2018-05-01
4
C
0
2601373
0.00
D
Common Stock
2658418
0
I
See footnote
Series A-1 Preferred Stock
2018-05-01
4
C
0
1264222
0.00
D
Common Stock
1264222
0
I
See footnote
Series B Preferred Stock
2018-05-01
4
C
0
8546742
0.00
D
Common Stock
8546742
0
I
See footnote
Series B-1 Preferred Stock
2018-05-01
4
C
0
1392050
0.00
D
Common Stock
1392050
0
I
See footnote
Series C Preferred Stock
2018-05-01
4
C
0
1533237
0.00
D
Common Stock
1533237
0
I
See footnote
Series D Preferred Stock
2018-05-01
4
C
0
195759
0.00
D
Common Stock
195759
0
I
See footnote
Each 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.
Includes 2,627,157 shares held by Ignition Venture Partners II, L.P. and 137,689 shares held by Ignition Managing Directors Fund II, LLC. Ignition GP II, LLC possesses all voting and dispositive power with respect to shares held by Ignition Venture Partners II, L.P. A board of nine managing directors controls all voting and dispositive power with respect to Ignition GP II, LLC, including with respect to shares held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. The board is comprised of Jonathan Roberts, Jon Anderson, John Connors, Robert Headley, Steve Hooper, Cameron Myhrvold, Brad Silverberg, Rich Tong and John Zagula.
Each 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.
Includes 3,828,421 shares held by Ignition Venture Partners II, L.P. and 200,647 shares held by Ignition Managing Directors Fund II, LLC. Ignition GP II, LLC possesses all voting and dispositive power with respect to shares held by Ignition Venture Partners II, L.P. A board of nine managing directors controls all voting and dispositive power with respect to Ignition GP II, LLC, including with respect to shares held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. The board is comprised of Jonathan Roberts, Jon Anderson, John Connors, Robert Headley, Steve Hooper, Cameron Myhrvold, Brad Silverberg, Rich Tong and John Zagula.
Includes 11,949,537 shares held by Ignition Venture Partners II, L.P. and 626,273 shares held by Ignition Managing Directors Fund II, LLC. Ignition GP II, LLC possesses all voting and dispositive power with respect to shares held by Ignition Venture Partners II, L.P. A board of nine managing directors controls all voting and dispositive power with respect to Ignition GP II, LLC, including with respect to shares held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. The board is comprised of Jonathan Roberts, Jon Anderson, John Connors, Robert Headley, Steve Hooper, Cameron Myhrvold, Brad Silverberg, Rich Tong and John Zagula.
Includes 13,272,263 shares held by Ignition Venture Partners II, L.P. and 695,597 shares held by Ignition Managing Directors Fund II, LLC. Ignition GP II, LLC possesses all voting and dispositive power with respect to shares held by Ignition Venture Partners II, L.P. A board of nine managing directors controls all voting and dispositive power with respect to Ignition GP II, LLC, including with respect to shares held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. The board is comprised of Jonathan Roberts, Jon Anderson, John Connors, Robert Headley, Steve Hooper, Cameron Myhrvold, Brad Silverberg, Rich Tong and John Zagula.
Includes 14,729,146 shares held by Ignition Venture Partners II, L.P. and 771,951 shares held by Ignition Managing Directors Fund II, LLC. Ignition GP II, LLC possesses all voting and dispositive power with respect to shares held by Ignition Venture Partners II, L.P. A board of nine managing directors controls all voting and dispositive power with respect to Ignition GP II, LLC, including with respect to shares held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. The board is comprised of Jonathan Roberts, Jon Anderson, John Connors, Robert Headley, Steve Hooper, Cameron Myhrvold, Brad Silverberg, Rich Tong and John Zagula.
Includes 14,915,156 shares held by Ignition Venture Partners II, L.P. and 781,700 shares held by Ignition Managing Directors Fund II, LLC. Ignition GP II, LLC possesses all voting and dispositive power with respect to shares held by Ignition Venture Partners II, L.P. A board of nine managing directors controls all voting and dispositive power with respect to Ignition GP II, LLC, including with respect to shares held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. The board is comprised of Jonathan Roberts, Jon Anderson, John Connors, Robert Headley, Steve Hooper, Cameron Myhrvold, Brad Silverberg, Rich Tong and John Zagula.
Includes 39,085 shares sold by Ignition Managing Directors Fund II, LLC and 745,758 shares sold by Ignition Venture Partners II, L.P.
Includes 14,169,398 shares held by Ignition Venture Partners II, L.P. and 742,615 shares held by Ignition Managing Directors Fund II, LLC. Ignition GP II, LLC possesses all voting and dispositive power with respect to shares held by Ignition Venture Partners II, L.P. A board of nine managing directors controls all voting and dispositive power with respect to Ignition GP II, LLC, including with respect to shares held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. The board is comprised of Jonathan Roberts, Jon Anderson, John Connors, Robert Headley, Steve Hooper, Cameron Myhrvold, Brad Silverberg, Rich Tong and John Zagula.
The shares were held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. Ignition GP II, LLC possesses all voting and dispositive power with respect to shares held by Ignition Venture Partners II, L.P. A board of nine managing directors controls all voting and dispositive power with respect to Ignition GP II, LLC, including with respect to shares held by Ignition Venture Partners II, L.P. and Ignition Managing Directors Fund II, LLC. The board is comprised of Jonathan Roberts, Jon Anderson, John Connors, Robert Headley, Steve Hooper, Cameron Myhrvold, Brad Silverberg, Rich Tong and John Zagula.
/s/ Yanira Wong, Attorney-in-fact
2018-05-01