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