0001493152-18-003757.txt : 20180322 0001493152-18-003757.hdr.sgml : 20180322 20180322165026 ACCESSION NUMBER: 0001493152-18-003757 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180321 FILED AS OF DATE: 20180322 DATE AS OF CHANGE: 20180322 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ronaldi Jeffrey CENTRAL INDEX KEY: 0001580473 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32146 FILM NUMBER: 18707474 MAIL ADDRESS: STREET 1: C/O DOCUMENT SECURITY SYSTEMS, INC. STREET 2: 28 EAST MAIN STREET, SUITE 1525 CITY: ROCHESTER STATE: NY ZIP: 14614 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 4 1 form4.xml X0306 4 2018-03-21 0 0000771999 DOCUMENT SECURITY SYSTEMS INC DSS 0001580473 Ronaldi Jeffrey C/O DOCUMENT SECURITY SYSTEMS, INC. 200 CANAL VIEW BLVD, SUITE 300 ROCHESTER NY 14623 1 1 0 0 CEO Common Stock 2018-03-21 4 A 0 50000 0 A 520603 D Issued to the Reporting Person from Issuer's 2013 Employee, Director and Consultant Equity Incentive plan as a common stock bonus pursuant to the terms of the Employment Agreement dated December 30,2016 between the Issuer and the Reporting Person. /s/ Jeffrey Ronaldi 2018-03-22