Filing Details

Accession Number:
0001493152-17-010498
Form Type:
4
Zero Holdings:
No
Publication Time:
2017-09-12 17:00:14
Reporting Period:
2017-09-08
Accepted Time:
2017-09-12 17:00:14
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
1261725 Ambrose Fai Heng Chan C/o Document Security Systems, Inc.
200 Canal View Blvd., Suite 300
Rochester NY 14623
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 2017-09-08 800,000 $0.75 1,100,000 No 4 P Indirect See Footnote
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Indirect See Footnote
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Warrants Acquisiton 2017-09-08 160,000 $0.00 160,000 $1.00
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
160,000 2017-09-08 2022-09-08 No 4 P Indirect
Reported Non-Derivative Holdings
Sec. Name Remaning Holdings Nature of Ownership Explanation
Common Stock 2,611 Direct
Reported Derivative Holdings
Sec. Name Sec. Type Price Date Expiration Date Amount Remaning Holdings Nature of Ownership
Common Stock Warrants $1.00 2016-12-29 2019-12-29 200,000 200,000 Indirect
Expiration Date Amount Remaning Holdings Nature of Ownership
2019-12-29 200,000 200,000 Indirect
Footnotes
  1. The Reporting Person is a director of BMI Capital Partners International Ltd. ("BMI Capital"), which owns 300,000 shares of the Issuer's common stock purchased on 12/29/16. The Reporting Person is also the CEO and majority shareholder of Heng Fai Holdings Limited ("HF Holdings"), which owns the 800,000 shares of Issuer's common stock purchased on 9/8/17. Reporting Person has dispositive control over all of these shares.
  2. BMI capital owns the previously issued warrants to purchase 200,000 shares of the Issuer's common stock. HF Holdings owns the warrants to purchase 160,000 shares of Issuer's common stock. Reporting Person has dispositive control over all of these warrants.
  3. The price of the warrants is included in the price of the shares reported in Table I.