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