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