Filing Details

Accession Number:
0001144204-15-055445
Form Type:
4
Zero Holdings:
No
Publication Time:
2015-09-17 16:01:05
Reporting Period:
2015-09-15
Filing Date:
2015-09-17
Accepted Time:
2015-09-17 16:01:05
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
771999 Document Security Systems Inc DSS Paperboard Containers & Boxes (2650) 161229730
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1215183 B Robert Fagenson C/O Document Security Systems, Inc.
28 East Main Street, Suite 1525
Rochester NY 14614
Yes No No No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2015-09-15 454,545 $0.22 1,335,321 No 4 P Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Direct
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Warrant Acquisiton 2015-09-15 90,909 $0.00 90,909 $0.40
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
90,909 2016-03-16 2020-03-16 No 4 P Direct
Footnotes
  1. Does not include, as previously reported on Form 4, 100,000 shares of the Issuer's common stock ("Common Stock") owned by the Reporting Person's spouse, 50,000 shares of Common Stock owned by a trust for the benefit of Stephanie Fagenson, and 50,000 shares of Common Stock owned by a trust for the benefit of Jennifer Fagenson.
  2. Warrant issued at no additional cost in connection with the Reporting Person's purchase of 454,545 shares of Common Stock from the Issuer.