0001493152-16-013620.txt : 20160927 0001493152-16-013620.hdr.sgml : 20160927 20160927175422 ACCESSION NUMBER: 0001493152-16-013620 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160923 FILED AS OF DATE: 20160927 DATE AS OF CHANGE: 20160927 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DOCUMENT SECURITY SYSTEMS INC CENTRAL INDEX KEY: 0000771999 STANDARD INDUSTRIAL CLASSIFICATION: PAPERBOARD CONTAINERS & BOXES [2650] IRS NUMBER: 161229730 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 200 CANAL VIEW BOULEVARD STREET 2: SUITE 300 CITY: ROCHESTER STATE: NY ZIP: 14623 BUSINESS PHONE: 585 232 1500 MAIL ADDRESS: STREET 1: 200 CANAL VIEW BOULEVARD STREET 2: SUITE 300 CITY: ROCHESTER STATE: NY ZIP: 14623 FORMER COMPANY: FORMER CONFORMED NAME: NEW SKY COMMUNICATIONS INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: THOROUGHBREDS USA INC DATE OF NAME CHANGE: 19861118 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FAGENSON ROBERT B CENTRAL INDEX KEY: 0001215183 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32146 FILM NUMBER: 161905352 MAIL ADDRESS: STREET 1: FAGENSON & CO. INC STREET 2: 60 BROAD STREET CITY: NEW YORK STATE: NY ZIP: 10004 4 1 form4.xml X0306 4 2016-09-23 0 0000771999 DOCUMENT SECURITY SYSTEMS INC DSS 0001215183 FAGENSON ROBERT B C/O DOCUMENT SECURITY SYSTEMS, INC. 200 CANAL VIEW BLVD, SUITE 300 ROCHESTER NY 14623 1 0 0 0 Common Stock 2016-09-23 4 P 0 7100 0.61 A 290931 D Common Stock 2016-09-26 4 P 0 1025 0.61 A 291956 D Common Stock 50000 I See Footnote Amounts reflect a 1-for-4 reverse stock split which was affected by DSS on August 26, 2016. Consists of 25,000 shares held by Mr. Fagenson's wife, and an aggregate of 25,000 shares held in trusts for Mr. Fagenson's two adult children, of which Mr. Fagenson is trustee. Mr. Fagenson disclaims beneficial ownership of these 50,000 shares. /s/ Robert B. Fagenson 2016-09-27