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