Heng Fai Ambrose Chan - May 26, 2021 Form 4 Insider Report for DOCUMENT SECURITY SYSTEMS INC (DSS)

Role: Director, 10%+ Owner
Signature: /s/ Heng Fai Ambrose Chan
Stock symbol: DSS
Transactions as of: May 26, 2021
Transactions value $: $0
Form type: 4
Date filed: 5/27/2021, 08:03 PM
Previous filing: May 14, 2021
Next filing: Jun 9, 2021

Transactions Table

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Ownership	Footnotes
transaction	DSS	Common Stock	Conversion of derivative security		+5.45M	+475.64%		6.6M	May 26, 2021	See footnote	F1, F2, F3

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Underlying Class	Amount	Exercise Price	Ownership	Footnotes
transaction	DSS	Series A Convertible Preferred Stock	Conversion of derivative security		-35.3K	-82.95%		7.26K	May 26, 2021	Common Stock	5.45M		See footnote	F1, F2, F3

* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id	Content
F1	Global BioMedical Pte. Ltd. ("GBM") has converted 35,316 shares of Series A Convertible Preferred Stock into 5,450,000 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 33,120,125 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 201 shares of Series A Preferred Stock, equal to 31,018 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.