0001829126-23-006223.txt : 20230920 0001829126-23-006223.hdr.sgml : 20230920 20230920202534 ACCESSION NUMBER: 0001829126-23-006223 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230918 FILED AS OF DATE: 20230920 DATE AS OF CHANGE: 20230920 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Liu Dong CENTRAL INDEX KEY: 0001813729 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41062 FILM NUMBER: 231267595 MAIL ADDRESS: STREET 1: 311 WEST 43RD STREET, 12TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mountain Crest Global Holdings LLC CENTRAL INDEX KEY: 0001859046 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41062 FILM NUMBER: 231267596 BUSINESS ADDRESS: STREET 1: 311 WEST 43RD STREET, 12TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 BUSINESS PHONE: 646-493-6558 MAIL ADDRESS: STREET 1: 311 WEST 43RD STREET, 12TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Mountain Crest Acquisition Corp. V CENTRAL INDEX KEY: 0001859035 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 311 WEST 43RD STREET, 12TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 BUSINESS PHONE: 646-493-6558 MAIL ADDRESS: STREET 1: 311 WEST 43RD STREET, 12TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 4 1 ownership.xml FORM 4 X0508 4 2023-09-18 0 0001859035 Mountain Crest Acquisition Corp. V MCAG 0001859046 Mountain Crest Global Holdings LLC 311 WEST 43RD STREET, 12TH FLOOR NEW YORK NY 10036 0 0 1 0 0001813729 Liu Dong 311 WEST 43RD STREET, 12TH FLOOR NEW YORK NY 10036 0 0 1 0 0 Common Stock 2023-09-18 4 J 0 75000 A 2015800 D On February 15, 2023, Mountain Crest Acquisition Corp. V (the "Company") issued a non-interest bearing, unsecured promissory note in the aggregate principal amount of $300,000 (the "Note") to the Reporting Person. On September 13, 2023, as approved by the Company's audit committee, the Company entered into a note conversion agreement (the "Note Conversion Agreement") with the Reporting Person, to convert the principal amount of the Note into 75,000 shares of the Company's Common Stock at $4:00 per share. On September 18, 2023, the Company issued 75,000 shares to the Reporting Person in satisfaction of the Note. The Shares are owned by Mountain Crest Global Holdings LLC, and Dong Liu, the sole manager of Mountain Crest Global Holdings LLC, has sole voting and dispositive power over the shares owned by Mountain Crest Global Holdings LLC. By: /s/ Dong Liu Name: Dong Liu Title: Manager 2023-09-20 By: /s/ Dong Liu 2023-09-20