0001209191-18-013131.txt : 20180223 0001209191-18-013131.hdr.sgml : 20180223 20180223175355 ACCESSION NUMBER: 0001209191-18-013131 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20180222 FILED AS OF DATE: 20180223 DATE AS OF CHANGE: 20180223 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KATZMAN RICHARD CENTRAL INDEX KEY: 0001190621 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38053 FILM NUMBER: 18638002 MAIL ADDRESS: STREET 1: KAZ INC STREET 2: 1775 BROADWAY SUITE 2405 CITY: NEW YORK STATE: NY ZIP: 10019 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ConvergeOne Holdings, Inc. CENTRAL INDEX KEY: 0001697152 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 814619427 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 135 EAST 57TH STREET, 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2127397860 MAIL ADDRESS: STREET 1: 135 EAST 57TH STREET, 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 FORMER COMPANY: FORMER CONFORMED NAME: Forum Merger Corp DATE OF NAME CHANGE: 20170203 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-02-22 0 0001697152 ConvergeOne Holdings, Inc. CVON 0001190621 KATZMAN RICHARD C/O CONVERGEONE HOLDINGS, INC. 3344 HIGHWAY 149 EAGAN MN 55121 1 0 0 0 Common Stock 2018-02-22 4 P 0 125000 8.00 A 125000 I By Katzman Family LLC Common Stock 2018-02-22 4 J 0 48375 A 48375 D Warrant (Right to Buy) 11.50 2018-02-22 4 J 0 7500 0.00 A 2018-04-12 2023-02-22 Common Stock 7500 7500 D Mr. Katzman is the investment manager of Katzman Family LLC and has sole voting and investment power with respect to the shares held by Katzman Family LLC. Richard Katzman received 48,375 shares of Common Stock of the Issuer as result of stock transfer made by Forum Investors I, LLC on February 22, 2018. Richard Katzman received a warrant to purchase up to 7,500 shares of Common Stock of the Issuer as result of transfer made by Forum Investors I, LLC on February 22, 2018. The warrant will become exercisable 12 months from the closing of the Issuer's initial public offering, which occurred on April 12, 2017. The 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 Issuer, 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. /s/ Richard Katzman 2018-02-23 EX-24.4_772062 2 poa.txt POA DOCUMENT POWER OF ATTORNEY Know all by these presents that the undersigned hereby constitutes and appoints each John A. McKenna, Jr. and Jeffrey Nachbor of ConvergeOne Holdings, Inc. (the "Company") and Mehdi Khodadad, John T. McKenna and Alan Hambelton of Cooley LLP, signing individually, the undersigned's true and lawful attorneys-in fact and agents to: (1) prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the Securities and Exchange Commission (the "SEC") a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section 16(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act") or any rule or regulation thereunder; (2) prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the SEC Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in connection therewith) with respect to the securities of the Company in accordance with Section 16(a) of Exchange Act and the rules thereunder; (3) do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to prepare and execute any such Form 3, 4 or 5 (including amendments thereto and joint filing agreements in connection therewith) and file such Forms with the SEC and any stock exchange, self-regulatory association or any other authority; and (4) take any other action of any type whatsoever in connection with the foregoing that, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required of the undersigned, it being understood that the documents executed by the attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as the attorney-in-fact may approve in the attorney-in-fact's discretion. The undersigned hereby grants to each such attorney in fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney in fact, or such attorney in fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, and their substitutes, in serving in such capacity at the request of the undersigned, are not assuming (nor is the Company assuming) any of the undersigned's responsibilities to comply with Section 16 of the Exchange Act. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the Company and the attorneys-in fact. This Power of Attorney revokes any other power of attorney that the undersigned has previously granted to representatives of the Company and Cooley LLP. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of the date written below. Dated: February 14, 2018 By: /s/ Richard Katzman Richard Katzman Signature Printed Name