Sec Form 5 Filing - GREEN HOLCOMBE T JR @ Fusion Connect, Inc. - 2018-12-31

Insider filing report for Changes in Beneficial Ownership
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FORM 5
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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
GREEN HOLCOMBE T JR
2. Issuer Name and Ticker or Trading Symbol
Fusion Connect, Inc. [ FSNN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O FUSION CONNECT, INC., 420 LEXINGTON AVENUE SUITE 1718
3. Date of Earliest Transaction (MM/DD/YY)
12/31/2018
(Street)
NEW YORK, NY10170
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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 06/19/2018 G V 120,000 D $ 0 23,064,347 I See Footnote ( 1 )
Common Stock 20,059,634 I See Footnote ( 2 )
Common Stock 1,287,548 I By The Holcombe T. Green, Jr. 2013 Five-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 321,886 I By The HTG III 2015 Five-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 321,886 I By The FHG 2015 Five-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 643,774 I By The FHG 2017 Two-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 643,774 I By The FHG 2017 Four-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 643,774 I By The HTG III 2017 Two-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 643,774 I By The HTG III 2017 Four-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 1,072,957 I By The FHG 2018 Two-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 536,478 I By The FHG 2018 Four-Year Annuity Trust ( 1 ) ( 3 )
Common Stock 536,478 I By The FHG 2018 Five-Year Annuity Trust ( 1 ) ( 3 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
GREEN HOLCOMBE T JR
C/O FUSION CONNECT, INC.
420 LEXINGTON AVENUE SUITE 1718
NEW YORK, NY10170
X X
Signatures
/s/ Holcombe T. Green, Jr 02/13/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The shares of Common Stock were issued as merger consideration to BCHI Holdings LLC ("BCHI") with respect to the merger of Birch Communications Holdings Inc. with and into Fusion BCHI Acquisition LLC, a wholly-owned subsidiary of the Issuer. The Reporting Person is the managing member of BCHI and may be deemed to beneficially own the shares of Common Stock held by BCHI to the extent set forth in this report because he has voting and dispositive power over such shares. The reporting person disclaims beneficial ownership except to the extent of the reporting person's pecuniary interest.
( 2 )Shares for which the Reporting Person shares dipositive power as the managing member of BCHI but for which the Reporting Person has no pecuniary interest. The Reporting Person disclaims beneficial ownership of such shares.
( 3 )The Reporting Person is trustee of (i) The Holcombe T. Green, Jr. 2013 Five-Year Annuity Trust, (ii) The HTG III 2015 Five-Year Annuity Trust, (iii) The FHG 2015 Five-Year Annuity Trust, (iv) The FHG 2017 Two-Year Annuity Trust, (v) The FHG 2017 Four-Year Annuity Trust, (vi) The HTG III 2017 Two-Year Annuity Trust, (vii) The HTG III 2017 Four-Year Annuity Trust, (viii) The FHG 2018 Two-Year Annuity Trust, (ix) The FHG 2018 Four-Year Annuity Trust and (x) The FHG 2018 Five-Year Annuity Trust.

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