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