0001493152-17-000479.txt : 20170113 0001493152-17-000479.hdr.sgml : 20170113 20170113161100 ACCESSION NUMBER: 0001493152-17-000479 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170112 FILED AS OF DATE: 20170113 DATE AS OF CHANGE: 20170113 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: Bzdick Robert B. CENTRAL INDEX KEY: 0001484889 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32146 FILM NUMBER: 17527874 MAIL ADDRESS: STREET 1: 28 MAIN STREET EAST STREET 2: SUITE 1525 CITY: ROCHESTER STATE: NY ZIP: 14614 4 1 form4.xml X0306 4 2017-01-12 0 0000771999 DOCUMENT SECURITY SYSTEMS INC DSS 0001484889 Bzdick Robert B. 935 RACOON RUN VICTOR NY 14564 1 1 0 0 President Common Stock 2017-01-12 4 A 0 50000 A 304996 D Issued to Reporting Person From Issuer's 2013 Employee, Director and Consultant Equity Incentive Plan for services previously provided to the Issuer. Common Stock grant will vest on May 17, 2017. Amount reflects a 1-for-4 reverse stock split which was affected by the Issuer on August 26, 2016. /s/ Robert B. Bzdick 2017-01-13