SEC Form 4 · accession 0000899243-18-005536

ConvergeOne Holdings, Inc. · CVON

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

Reporting owner

Other

Period of report

Feb 22, 2018

Accepted (ET)

Feb 26, 2018 · 6:59 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^F2,F3	Feb 22, 2018	P	312,500	$8.00	A	312,500	I	See Footnote
Common Stock^F1,F2,F3	Feb 22, 2018	J	126,250	$0.00	A	438,750	I	See Footnote

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

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.
F2These securities are owned by the NeilGoldberg 1995 Irrevocable Trust of which the person is the trustee.
F3The 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.
F4The warrant will become exercisable 12 months from the closing of the registrant 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.

Mr. Goldberg resigned as a Director of the registrant effective February 22, 2018.