0001213900-17-006860.txt : 20170627 0001213900-17-006860.hdr.sgml : 20170627 20170627162330 ACCESSION NUMBER: 0001213900-17-006860 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170623 FILED AS OF DATE: 20170627 DATE AS OF CHANGE: 20170627 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: KBL MERGER CORP. IV CENTRAL INDEX KEY: 0001690080 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 813832378 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 150 WEST 56TH STREET SUITE 5901 CITY: NEW YORK STATE: NY ZIP: 10019 BUSINESS PHONE: 212-319-5555 MAIL ADDRESS: STREET 1: 150 WEST 56TH STREET SUITE 5901 CITY: NEW YORK STATE: NY ZIP: 10019 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KBL IV SPONSOR LLC CENTRAL INDEX KEY: 0001706868 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38105 FILM NUMBER: 17932609 BUSINESS ADDRESS: STREET 1: 527 STANTON CHRISTIANA ROAD CITY: NEWARK STATE: DE ZIP: 19713 BUSINESS PHONE: 3025022727 MAIL ADDRESS: STREET 1: 527 STANTON CHRISTIANA ROAD CITY: NEWARK STATE: DE ZIP: 19713 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KRAUSS MARLENE CENTRAL INDEX KEY: 0001033308 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38105 FILM NUMBER: 17932610 MAIL ADDRESS: STREET 1: C/O KBL HEALTHCARE INC STREET 2: 645 MADISON AVE CITY: NEW YORK STATE: NY ZIP: 10022 4 1 f4062317krauss_kblmerger.xml OWNERSHIP DOCUMENT X0306 4 2017-06-23 0 0001690080 KBL MERGER CORP. IV KBLMU 0001033308 KRAUSS MARLENE 527 STANTON CHRISTIANA RD. NEWARK DE 19713 1 1 1 0 Chief Executive Officer 0001706868 KBL IV SPONSOR LLC 527 STANTON CHRISTIANA ROAD NEWARK DE 19713 0 0 1 0 Common Stock 2017-06-23 4 P 0 27500 10 A 3252500 D These shares are underlying units (each unit consisting of one share of common stock, one right entitling the holder thereof to receive one-tenth (1/10) of one share of common stock upon the consummation of an initial business combination and one warrant to purchase one-half of one share of common stock) held by KBL IV Sponsor LLC (the "Sponsor"), acquired pursuant to a third amended and restated unit purchase agreement by and between the Sponsor and the issuer. Such units were purchased upon the exercise of the underwriters' over-allotment option in connection with the issuer's initial public offering. Each of the issuer's officers and directors is a member of the Sponsor. Dr. Marlene Krauss, the issuer's Chief Executive Officer, is the sole managing member of the Sponsor. Consequently, she may be deemed the beneficial owner of the shares of common stock held by the Sponsor and has sole voting and dispositive control over such securities. Dr. Krauss disclaims beneficial ownership over any securities owned by the Sponsor in which she does not have a pecuniary interest. /s/ Marlene Krauss, M.D. 2017-06-27 /s/ Marlene Krauss, M.D., as Managing Member of KBL IV Sponsor LLC 2017-06-27