0001213900-23-057929.txt : 20230718
0001213900-23-057929.hdr.sgml : 20230718
20230718172909
ACCESSION NUMBER: 0001213900-23-057929
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230717
FILED AS OF DATE: 20230718
DATE AS OF CHANGE: 20230718
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: 231095107
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: 231095108
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: 231095109
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: 231095110
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
X0508
4
2023-07-17
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
0
Class A Common Stock
2023-07-17
4
D
0
834023
0
D
0
I
By Forum Investors IV LLC
Class B Common Stock
2023-07-17
4
D
0
8400377
D
Class A Common Stock
8400377
0
I
By Forum Investors IV LLC
On June 22, 2023, the Issuer announced that its board of directors had determined to redeem all of its outstanding shares of Class A common stock sold in the Issuer's initial public offering (the "Public Shares"), effective as of June 22, 2023, because the Issuer will not be able to consummate an initial business combination within the time period required by its amended and restated certificate of incorporation. As of the close of business on June 22, 2023, the Public Shares were deemed cancelled and represented only the rights to receive the per-share redemption price. In connection with the redemption of the Public Shares and anticipated dissolution of the Issuer, on July 17, 2023, Forum Investors IV LLC (the "Sponsor") forfeited to the Issuer for no consideration 8,400,377 shares of Class B common stock and 834,023 shares of Class A common stock.
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.
The shares of Class B common stock were convertible for shares of the Issuer's Class A common stock at the time of the Issuer's initial business combination as described under the heading "Description of Securities" in the Issuer's Registration Statement on Form S-1 (File No. 333-253216) (the "Registration Statement") and had no expiration date.
/s/ Elliott Smith, Attorney-in-Fact for Forum Investors IV LLC
2023-07-18
/s/ Elliott Smith, Attorney-in-Fact for Forum Capital Management IV LLC
2023-07-18
/s/ Elliott Smith, Attorney-in-Fact for Marshall Kiev
2023-07-18
/s/ Elliott Smith, Attorney-in-Fact for David Boris
2023-07-18