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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KRAUSS MARLENE 527 STANTON CHRISTIANA RD. NEWARK, DE 19713 |
X | X | Chief Executive Officer | |
KBL IV SPONSOR LLC 527 STANTON CHRISTIANA ROAD NEWARK, DE 19713 |
X |
/s/ Marlene Krauss, M.D. | 06/09/2017 | |
**Signature of Reporting Person | Date | |
/s/ Marlene Krauss, M.D., as Managing Member of KBL IV Sponsor LLC | 06/09/2017 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | These shares are underlying units (each unit consisting of one share of common stock, one right entitling the holder thereof to receive one-tenth (1/10) of one share of common stock upon the consummation of an initial business combination and one warrant to purchase one-half of one share of common stock) held by KBL IV Sponsor LLC (the "Sponsor"), acquired pursuant to a third amended and restated unit purchase agreement by and between the Sponsor and the issuer. |
(2) | Each of the issuer's officers and directors is a member of the Sponsor. Dr. Marlene Krauss, the issuer's Chief Executive Officer, is the sole managing member of the Sponsor. Consequently, she may be deemed the beneficial owner of the shares of common stock held by the Sponsor and has sole voting and dispositive control over such securities. Dr. Krauss disclaims beneficial ownership over any securities owned by the Sponsor in which she does not have a pecuniary interest. |
(3) | Includes up to 375,000 shares of common stock that are subject to forfeiture in the event that the underwriters of the issuer's initial public offering do not exercise their over-allotment option in full. |