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