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