0001261333-20-000019.txt : 20200313 0001261333-20-000019.hdr.sgml : 20200313 20200313174722 ACCESSION NUMBER: 0001261333-20-000019 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200131 FILED AS OF DATE: 20200313 DATE AS OF CHANGE: 20200313 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Wolberg Kirsten O. CENTRAL INDEX KEY: 0001664367 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38465 FILM NUMBER: 20714291 MAIL ADDRESS: STREET 1: 900 NORTH MCCARTHY BLVD CITY: MILPITAS STATE: CA ZIP: 95035 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 1550 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 BUSINESS PHONE: 415-489-4940 MAIL ADDRESS: STREET 1: 221 MAIN ST., SUITE 1550 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 FORMER COMPANY: FORMER CONFORMED NAME: DOCUSIGN INC DATE OF NAME CHANGE: 20030826 5 1 wf-form5_158413602532925.xml FORM 5 X0306 5 2020-01-31 0 0 0 0001261333 DOCUSIGN, INC. DOCU 0001664367 Wolberg Kirsten O. C/O DOCUSIGN, INC. 221 MAIN STREET, SUITE 1550 SAN FRANCISCO CA 94105 0 1 0 0 Chief Technology & Ops Officer Common Stock 2020-01-10 5 G 0 486 0 D 145300 D Common Stock 2020-01-10 5 G 0 486 0 A 486 I By First Child's Trust Common Stock 2020-01-10 5 G 0 486 0 D 144814 D Common Stock 2020-01-31 5 G 0 486 0 A 486 I By Second Child's Trust This transaction involved a gift of securities by the Reporting Person to a trust for the benefit of her first child, who shares the Reporting Person's household. The Reporting Person disclaims beneficial ownership of the shares held in the first child's trust, and this report should not be deemed an admission that the Reporting Person is the beneficial owner of the shares held in the trust for purposes of Section 16 or for any other purpose. This transaction involved a gift of securities by the Reporting Person to a trust for the benefit of her second child, who shares the Reporting Person's household. The Reporting Person disclaims beneficial ownership of the shares held in the second child's trust, and this report should not be deemed an admission that the Reporting Person is the beneficial owner of the shares held in the trust for purposes of Section 16 or for any other purpose. /s/ Apple Palarca, Attorney-in-fact 2020-03-13