0000899243-18-005529.txt : 20180226 0000899243-18-005529.hdr.sgml : 20180226 20180226184130 ACCESSION NUMBER: 0000899243-18-005529 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180222 FILED AS OF DATE: 20180226 DATE AS OF CHANGE: 20180226 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: 001-38053 FILM NUMBER: 18642267 MAIL ADDRESS: STREET 1: 135 EAST 57TH STREET 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 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: 135 EAST 57TH STREET, 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2127397860 MAIL ADDRESS: STREET 1: 135 EAST 57TH STREET, 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 FORMER COMPANY: FORMER CONFORMED NAME: Forum Merger Corp DATE OF NAME CHANGE: 20170203 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-02-22 1 0001697152 ConvergeOne Holdings, Inc. CVON 0001701748 Kiev Marshall 135 EAST 57TH STREET 8TH FLOOR NEW YORK NY 10022 0 0 0 1 See Remarks Common Stock 2018-02-22 4 J 0 655062 0.00 A 655062 D Common Stock 2018-02-22 4 J 0 163765 0.00 A 818827 I By MK 2016 Trust Common Stock 2018-02-22 4 J 0 111250 0.00 A 930077 I By APJM Warrants 11.50 2018-02-22 4 J 0 25000 0.00 A 2018-04-12 2023-02-22 Common Stock 25000 25000 I By APJM Represents receipt of the reporting person's pro rata distribution of the shares of common stock and warrants of the registrant held by Forum Investors I, LLC. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. The reporting person is the managing member of APJM. The warrant will become exercisable 12 months from the closing of the registrant's initial public offering, which occurred on April 12, 2017. The warrant will expire five years after the completion of that certain Agreement and Plan of Merger, dated as of November 30, 2017, by and among the registrant, FMC Merger Subsidiary Corp., FMC Merger Subsidiary LLC, Old C1 and Clearlake Capital Management III, L.P. in the capacity as the Seller Representative, or earlier upon redemption. Former Director, Co-Chief Executive Officer, President Mr. Kiev resigned as a Director, Co-Chief Executive Officer, President of the registrant effective February 22, 2018. /s/ Marshall Kiev 2018-02-26