0001567619-21-012721.txt : 20210629
0001567619-21-012721.hdr.sgml : 20210629
20210629171858
ACCESSION NUMBER: 0001567619-21-012721
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210625
FILED AS OF DATE: 20210629
DATE AS OF CHANGE: 20210629
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Adjemian Kevork Tro
CENTRAL INDEX KEY: 0001869016
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39457
FILM NUMBER: 211059183
MAIL ADDRESS:
STREET 1: 1055 W. SQUARE LAKE ROAD
CITY: TROY
STATE: MI
ZIP: 48098
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Electric Last Mile Solutions, Inc.
CENTRAL INDEX KEY: 0001784168
STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLES & PASSENGER CAR BODIES [3711]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1055 W. SQUARE LAKE ROAD
CITY: TROY
STATE: MI
ZIP: 48098
BUSINESS PHONE: 888-825-9111
MAIL ADDRESS:
STREET 1: 1055 W. SQUARE LAKE ROAD
CITY: TROY
STATE: MI
ZIP: 48098
FORMER COMPANY:
FORMER CONFORMED NAME: Forum Merger III Corp
DATE OF NAME CHANGE: 20190731
4
1
doc1.xml
FORM 4
X0306
4
2021-06-25
0
0001784168
Electric Last Mile Solutions, Inc.
ELMS
0001869016
Adjemian Kevork Tro
1055 W SQUARE LAKE ROAD
TROY
MI
48098
0
1
0
0
Chief Technical Officer
Common Stock
2021-06-25
4
C
0
55044
A
55044
I
by KA Trust
Convertible Note
2021-06-25
4
C
0
55044
D
Common Stock
55044
0
I
by KA Trust
Shares were issued to the reporting person upon conversion of an aggregate of $500,404.79 in principal and accrued interest under a convertible note owed to the reporting person.
The reporting person has sole voting and investment power with respect to the shares of common stock held by the KA Trust.
On December 10, 2020, Electric Last Mile, Inc. ("ELM") entered into a $500,000 Convertible Note with KA Trust. The reporting person is the beneficial owner of the Convertible Note issued to KA Trust. Pursuant to the terms of the Convertible Note, upon the closing of the transaction contemplated pursuant to the Agreement and Plan of Merger, dated as of December 10, 2020, by and among Forum Merger III Corporation ("Forum") (upon consummation of the business combination, the surviving "Issuer" is renamed "Electric Last Mile Solutions, Inc."), ELMS Merger Corp., a wholly owned subsidiary of Forum, and ELM, as amended, the Convertible Note will be converted into shares of common stock of Electric Last Mile Solutions, Inc.
/s/ Benjamin Wu, attorney-in-fact for Kevork Tro Adjemian
2021-06-29