0001213900-17-003473.txt : 20170406
0001213900-17-003473.hdr.sgml : 20170406
20170406204652
ACCESSION NUMBER: 0001213900-17-003473
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170406
FILED AS OF DATE: 20170406
DATE AS OF CHANGE: 20170406
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Forum Merger Corp
CENTRAL INDEX KEY: 0001697152
STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770]
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Goldberg Neil
CENTRAL INDEX KEY: 0001701827
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38053
FILM NUMBER: 17747445
MAIL ADDRESS:
STREET 1: 135 EAST 57TH STREET 8TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10022
3
1
f3040617goldberg_forummerger.xml
OWNERSHIP DOCUMENT
X0206
3
2017-04-06
0
0001697152
Forum Merger Corp
FMCIU
0001701827
Goldberg Neil
135 EAST 57TH STREET
8TH FLOOR
NEW YORK
NY
10022
1
0
0
0
Class F Common Stock
0
Class A Common Stock
0
I
See Footnote
Mr. Goldberg does not beneficially own any shares of the common stock of the issuer. However, Mr. Goldberg has a pecuniary interest in shares of Class F common stock through his ownership of membership interests of Forum Investors I, LLC. As described in the issuer's registration statement on Form S-1 (File No. 333-216842) under the heading "Description of Securities--Founder Shares", the shares of Class F common stock will automatically convert into shares of Class A common stock at the time of the issuer's initial business combination, or earlier at the option of the holder, on a one-for-one basis, subject to adjustment for stock splits, stock dividends, reorganizations, recapitalizations and the like, and certain anti-dilution rights and has no expiration date.
/s/ Neil Goldberg
2017-04-06