0001209191-19-002196.txt : 20190104
0001209191-19-002196.hdr.sgml : 20190104
20190104174952
ACCESSION NUMBER: 0001209191-19-002196
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190104
FILED AS OF DATE: 20190104
DATE AS OF CHANGE: 20190104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jurasek Christopher
CENTRAL INDEX KEY: 0001454310
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38053
FILM NUMBER: 19511371
MAIL ADDRESS:
STREET 1: 13625 TECHNOLOGY DR
CITY: EDEN PRAIRIE
STATE: MN
ZIP: 55344-2252
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ConvergeOne Holdings, Inc.
CENTRAL INDEX KEY: 0001697152
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 814619427
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 3344 HIGHWAY 149
CITY: EAGAN
STATE: MN
ZIP: 55121
BUSINESS PHONE: 651-393-3632
MAIL ADDRESS:
STREET 1: 3344 HIGHWAY 149
CITY: EAGAN
STATE: MN
ZIP: 55121
FORMER COMPANY:
FORMER CONFORMED NAME: Forum Merger Corp
DATE OF NAME CHANGE: 20170203
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2019-01-04
1
0001697152
ConvergeOne Holdings, Inc.
CVON
0001454310
Jurasek Christopher
C/O CONVERGEONE HOLDINGS, INC.
3344 HIGHWAY 149
EAGAN
MN
55121
1
0
0
0
Common Stock
2019-01-04
4
D
0
262054
12.50
D
0
D
Consists of shares of common stock disposed of pursuant to the agreement and plan of merger, dated November 6, 2018, among PVKG Investment Holdings, Inc. ("Purchaser"), PVKG Merger Sub, Inc., a wholly owned subsidiary of Purchaser, and ConvergeOne Holdings, Inc., in exchange for $12.50 per share.
/s/ John T. McKenna, Attorney in Fact
2019-01-04