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