SEC Form 4 · accession 0000899243-18-005529

ConvergeOne Holdings, Inc. · CVON

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Marshall Kiev

Other

Period of report

Feb 22, 2018

Accepted (ET)

Feb 26, 2018 · 6:41 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001697152

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1	Feb 22, 2018	J	655,062	$0.00	A	655,062	D
Common Stock^F1,F2	Feb 22, 2018	J	163,765	$0.00	A	818,827	I	By MK 2016 Trust
Common Stock^F1,F2,F3	Feb 22, 2018	J	111,250	$0.00	A	930,077	I	By APJM

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Warrants^{F1,F2,F3,F4,F5}	$11.50	Feb 22, 2018	J	25,000	A	Apr 12, 2018	Feb 22, 2023	Common Stock	25,000	25,000	I

Explanation of responses

F1Represents 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.
F2The 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.
F3The reporting person is the managing member of APJM.
F4The warrant will become exercisable 12 months from the closing of the registrant's initial public offering, which occurred on April 12, 2017.
F5The 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.

Remarks

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.