DSS, INC. — Director's Dealing 2020

Oct 23, 2020

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: DOCUMENT SECURITY SYSTEMS INC (DSS)
CIK: 0000771999
Period of Report: 2020-10-16

Reporting Person: Chan Heng Fai Ambrose (Director, 10% Owner)
Reporting Person: Global BioMedical Pte. Ltd. (10% Owner)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2020-10-16	Common Stock	C	662500	—	Acquired	1145834	Indirect

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2020-10-16	Series A Convertible Preferred Stock	$	C	4293	Disposed		Common Stock (662500)	Indirect

Footnotes

F1: Global BioMedical Pte. Ltd. ("GBM") has converted 4,293 shares of Series A Convertible Preferred Stock into 662,500 shares of the common stock of Document Security Systems, Inc. (the "Issuer").

F2: The Series A Convertible Preferred Stock of the Issuer has a stated value of $1,000 per share and may be converted into shares of the common stock of the Issuer at a conversion price of $6.48 per share, subject to a 19.99% beneficial ownership conversion limitation (the "Blocker") based on the total issued and outstanding shares of common stock of the Issuer beneficially owned by GBM. There are currently 5,836,212 shares of the Issuer's common stock issued and outstanding, and therefore, as a result of the Blocker, GBM is currently able to convert an additional 168 shares of Series A Preferred Stock, equal to 25,925 shares of the Issuer's common stock. Mr. Chan has dispositive control over the securities owned by GBM.

F3: These securities are owned directly by GBM. Mr. Chan has dispositive control over the common stock and Series A Convertible Preferred Stock of the Issuer owned by GBM.