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