SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
KURTZ RICHARD

(Last) (First) (Middle)
C/O LAPOLLA INDUSTRIES, INC.
15402 VANTAGE PARKWAY EAST #322

(Street)
HOUSTON TX 77032

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
LAPOLLA INDUSTRIES INC [ LPAD ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) X Other (specify below)
Chairman of the Board
3. Date of Earliest Transaction (Month/Day/Year)
12/31/2009
4. If Amendment, Date of Original Filed (Month/Day/Year)
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. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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
Preferred Stock, Series D, PV $1.00 12/31/2009(1) A 5,840 A $1,000 13,816 D
Preferred Stock, Series D, PV $1.00 03/31/2010(2) A 19 A $1,000 13,835 D
Preferred Stock, Series D, PV $1.00 06/30/2010(3) A 1,407 A $1,000 15,242 D
Preferred Stock, Series D, PV $1.00 11/16/2010(4) D 10,000 D (4) 5,242 D
Common Stock, PV $.01 11/16/2010(4) A 19,600,573 A (4) 59,164,722 D
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 (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 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: 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
Explanation of Responses:
1. This transaction was previously disclosed in the Registrant's Form 10-K for the Year Ended December 31, 2009.
2. This transaction was previously disclosed in the Registrant's Form 10-Q for the Quarterly Period Ended March 31, 2010.
3. This transaction was previously disclosed in the Registrant's Form 10-Q for the Quarterly Period Ended June 30, 2010.
4. On November 16, 2010, I exchanged $10,000,000 of my Series D Preferred Stock, PV $.01, with a Stated Value of $1,000 per share, accruing dividends at 10% per annum, payable quarterly in arrears, plus unpaid and accrued outstanding Series D Preferred Stock dividends of $388,304 as of said date, for restricted common stock at a price per share of $.53 per share (the closing price of the Registrant's common stock as traded on the OTCBB was $.51 per share on said exchange date), or for 19,600,573 shares. This transaction was approved unanimously by all six disinterested members of the seven member Board of Directors of the Registrant, four of which are non-employee outside directors. This transaction was previously disclosed in the Registrant's Form 8-K dated November 10, 2010.
Remarks:
/s/ For Richard J. Kurtz By Michael T. Adams, AS/POA 11/19/2010
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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