0001213900-21-018814.txt : 20210330
0001213900-21-018814.hdr.sgml : 20210330
20210330181056
ACCESSION NUMBER: 0001213900-21-018814
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210330
FILED AS OF DATE: 20210330
DATE AS OF CHANGE: 20210330
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Boris David
CENTRAL INDEX KEY: 0001522248
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40230
FILM NUMBER: 21788784
MAIL ADDRESS:
STREET 1: C/O TRIO MERGER CORP.
STREET 2: 777 THIRD AVENUE, 37TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10017
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kiev Marshall
CENTRAL INDEX KEY: 0001701748
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40230
FILM NUMBER: 21788785
MAIL ADDRESS:
STREET 1: 135 EAST 57TH STREET 8TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Forum Capital Management IV LLC
CENTRAL INDEX KEY: 0001842903
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40230
FILM NUMBER: 21788786
BUSINESS ADDRESS:
STREET 1: 1615 SOUTH CONGRESS AVENUE
STREET 2: SUITE 103
CITY: DELRAY BEACH
STATE: FL
ZIP: 33445
BUSINESS PHONE: (212) 739-7860
MAIL ADDRESS:
STREET 1: 1615 SOUTH CONGRESS AVENUE
STREET 2: SUITE 103
CITY: DELRAY BEACH
STATE: FL
ZIP: 33445
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Forum Investors IV LLC
CENTRAL INDEX KEY: 0001842910
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40230
FILM NUMBER: 21788787
BUSINESS ADDRESS:
STREET 1: 1615 SOUTH CONGRESS AVENUE
STREET 2: SUITE 103
CITY: DELRAY BEACH
STATE: FL
ZIP: 33445
BUSINESS PHONE: (212) 739-7860
MAIL ADDRESS:
STREET 1: 1615 SOUTH CONGRESS AVENUE
STREET 2: SUITE 103
CITY: DELRAY BEACH
STATE: FL
ZIP: 33445
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Forum Merger IV Corp
CENTRAL INDEX KEY: 0001842916
STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770]
IRS NUMBER: 861556509
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1615 SOUTH CONGRESS AVENUE
STREET 2: SUITE 103
CITY: DELRAY BEACH
STATE: FL
ZIP: 33445
BUSINESS PHONE: (212) 739-7860
MAIL ADDRESS:
STREET 1: 1615 SOUTH CONGRESS AVENUE
STREET 2: SUITE 103
CITY: DELRAY BEACH
STATE: FL
ZIP: 33445
4
1
ownership.xml
OWNERSHIP DOCUMENT
X0306
4
2021-03-30
0
0001842916
Forum Merger IV Corp
FMIV
0001842910
Forum Investors IV LLC
C/O FORUM MERGER IV CORPORATION
1615 SOUTH CONGRESS AVENUE, SUITE 103
DELRAY BEACH
FL
33445
1
0
1
1
*Director by Deputization
0001842903
Forum Capital Management IV LLC
C/O FORUM MERGER IV CORPORATION
1615 SOUTH CONGRESS AVENUE, SUITE 103
DELRAY BEACH
FL
33445
1
0
1
0
0001701748
Kiev Marshall
C/O FORUM MERGER IV CORPORATION
1615 SOUTH CONGRESS AVENUE, SUITE 103
DELRAY BEACH
FL
33445
1
1
1
0
Co-CEO, President
0001522248
Boris David
C/O FORUM MERGER IV CORPORATION
1615 SOUTH CONGRESS AVENUE, SUITE 103
DELRAY BEACH
FL
33445
1
1
1
0
Co-CEO, CFO
Class A Common Stock
2021-03-30
4
J
0
54023
10
A
834023
D
Class B Common Stock
2021-03-30
4
J
0
224623
0
D
Class A Common Stock
224623
8400377
D
The reported shares of Class A Common Stock are within 54,023 of the Issuer's Private Placement Units, as described under the heading "Description of Securities" in the Issuer's registration statement on Form S-1 (File No. 333-253216), purchased by Forum Investors IV LLC (the "Sponsor") for $10.00 per Private Placement Unit.
The Sponsor is the record holder of the shares reported herein. Marshall Kiev and David Boris are the managing members of Forum Capital Management IV LLC, which is the managing member of the Sponsor. As such, Forum Capital Management IV LLC, David Boris and Marshall Kiev may be deemed to have beneficial ownership of the securities held directly by the Sponsor. Each such entity or person disclaims any beneficial ownership of the reported shares other than to the extent of any pecuniary interest they may have therein, directly or indirectly.
On March 30, 2021 Forum Investors IV LLC forfeited at no cost 224,623 shares of Class B common stock of the Issuer in connection with the election by the underwriters of the Issuer's initial public offering to exercise an option granted to them to cover over-allotments in part and not in full.
The shares of Class B common stock are convertible for shares of the Issuer's Class A common stock as described under the heading "Description of Securities" in the Issuer's Registration Statement on Form S-1 (File No. 333-248619) (the "Registration Statement") and have no expiration date.
/s/ Daniel Nussen, Attorney-in-Fact for Forum Investors IV LLC
2021-03-30
/s/ Daniel Nussen, Attorney-in-Fact for Forum Capital Management IV LLC
2021-03-30
/s/ Daniel Nussen, Attorney-in-Fact for Marshall Kiev
2021-03-30
/s/ Daniel Nussen, Attorney-in-Fact for David Boris
2021-03-30