Statement of Changes in Beneficial Ownership (4)
June 29 2021 - 4:20PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
Adjemian Kevork Tro |
2. Issuer Name and Ticker or Trading Symbol
Electric Last Mile Solutions, Inc.
[
ELMS
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Technical Officer |
(Last)
(First)
(Middle)
1055 W SQUARE LAKE ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/25/2021 |
(Street)
TROY, MI 48098
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
|
1.Title of Security (Instr. 3)
|
2. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. Code (Instr. 8)
|
4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
|
5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
|
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
|
7. Nature of Indirect Beneficial Ownership (Instr. 4)
|
Code
|
V
|
Amount
|
(A) or (D)
|
Price
|
Common Stock | 6/25/2021 | | C(1) | | 55044 | A | (1) | 55044 | I | by KA Trust (2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Convertible Note | (3) | 6/25/2021 | | C | | | 55044 | (3) | (3) | Common Stock | 55044 | (3) | 0 | I | by KA Trust (2) |
Explanation of Responses: |
(1) | Shares were issued to the reporting person upon conversion of an aggregate of $500,404.79 in principal and accrued interest under a convertible note owed to the reporting person. |
(2) | The reporting person has sole voting and investment power with respect to the shares of common stock held by the KA Trust. |
(3) | On December 10, 2020, Electric Last Mile, Inc. ("ELM") entered into a $500,000 Convertible Note with KA Trust. The reporting person is the beneficial owner of the Convertible Note issued to KA Trust. Pursuant to the terms of the Convertible Note, upon the closing of the transaction contemplated pursuant to the Agreement and Plan of Merger, dated as of December 10, 2020, by and among Forum Merger III Corporation ("Forum") (upon consummation of the business combination, the surviving "Issuer" is renamed "Electric Last Mile Solutions, Inc."), ELMS Merger Corp., a wholly owned subsidiary of Forum, and ELM, as amended, the Convertible Note will be converted into shares of common stock of Electric Last Mile Solutions, Inc. |
Reporting Owners
|
Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Adjemian Kevork Tro 1055 W SQUARE LAKE ROAD TROY, MI 48098 |
|
| Chief Technical Officer |
|
Signatures
|
/s/ Benjamin Wu, attorney-in-fact for Kevork Tro Adjemian | | 6/29/2021 |
**Signature of Reporting Person | Date |
Forum Merger III (NASDAQ:FIIIU)
Historical Stock Chart
From Jun 2024 to Jul 2024
Forum Merger III (NASDAQ:FIIIU)
Historical Stock Chart
From Jul 2023 to Jul 2024
Real-Time news about Forum Merger III Corporation (NASDAQ): 0 recent articles
More Electric Last Mile Solutions, Inc. News Articles