0001515156-23-000031.txt : 20230313 0001515156-23-000031.hdr.sgml : 20230313 20230313193722 ACCESSION NUMBER: 0001515156-23-000031 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230309 FILED AS OF DATE: 20230313 DATE AS OF CHANGE: 20230313 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Blank Jeremy CENTRAL INDEX KEY: 0001962987 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37822 FILM NUMBER: 23728793 MAIL ADDRESS: STREET 1: 6446 DREXEL AVENUE CITY: LOS ANGELES STATE: CA ZIP: 90048 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Advanced Emissions Solutions, Inc. CENTRAL INDEX KEY: 0001515156 STANDARD INDUSTRIAL CLASSIFICATION: MISCELLANEOUS CHEMICAL PRODUCTS [2890] IRS NUMBER: 275472457 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 8051 E. MAPLEWOOD AVE., STE 210 CITY: GREENWOOD VILLAGE STATE: CO ZIP: 80111 BUSINESS PHONE: 720-598-3500 MAIL ADDRESS: STREET 1: 8051 E. MAPLEWOOD AVE., STE 210 CITY: GREENWOOD VILLAGE STATE: CO ZIP: 80111 4 1 wf-form4_167875062414414.xml FORM 4 X0306 4 2023-03-09 0 0001515156 Advanced Emissions Solutions, Inc. ADES 0001962987 Blank Jeremy C/O ADVANCED EMISSIONS SOLUTIONS, INC. 8051 E. MAPLEWOOD AVENUE, SUITE 210 GREENWOOD VILLAGE CO 80111 1 0 0 0 Common Stock 2023-03-09 4 S 0 154293 4 D 477573 I By YGF 100 LP. Common Stock 2023-03-09 4 J 0 630619 A 1108192 I By YGF 100 LP. Common Stock 2023-03-09 4 J 0 19804 A 19804 I By Community SPV GP LP. Series A Convertible Preferred Stock 2023-03-09 4 J 0 737657 A 737657 I By YGF 100 LP. Series A Convertible Preferred Stock 2023-03-09 4 J 0 23166 A 23166 I By Community SPV GP LP. The shares reported on this row are held by YGF 100 LP ("YGF"). Jeremy Blank, a Director of the Issuer, is the ultimate control person of YGF. Mr. Blank is an investor in YGF and therefore is an indirect beneficial owner of a portion of these shares. Mr. Blank disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. Pursuant to that certain Share Buy Back Agreement, by and among Arq Limited and certain of its shareholders (the "Share Buy Back Agreement"), Arq Limited distributed shares of Common Stock, par value $0.001 per share (the "Common Stock") and shares of Series A Preferred Convertible Stock, par value $0.001 per share (the "Series A Preferred Stock"), to such shareholders in exchange for ordinary shares of Arq Limited held by such shareholders, in connection with the acquisition of Arq Limited by the Issuer. Pursuant to the Share Buy Back Agreement, certain shareholders of Arq Limited sold in the aggregate 90% of their ordinary shares in Arq and received in the aggregate 9.78 shares of Common Stock and 11.44 shares of Preferred Stock as consideration for every 1,000 ordinary shares in Arq sold (rounded down to the nearest whole share). The shares of the Issuer distributed in exchange for Arq Limited ordinary shares were valued at $4.00 per share. The shares reported on this row are held by Community SPV GP LP. Mr. Blank is the ultimate control person of Community SPV GP LP. Mr. Blank is an investor in Community SPV GP LP and therefore is an indirect beneficial owner of a portion of these shares. Mr. Blank disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. Each share of Series A Preferred Stock will be automatically converted into a share of Common Stock upon approval by the holders of the percentage of Common Stock required to approve such conversion under the applicable rules of The Nasdaq Stock Market, without the need for any action on the part of the holders of the Series A Preferred Stock (the "Conversion Approval"). Each share of Series A Preferred Stock is deemed to have an original issue price of $4.00 per share (the "Original Issue Amount"). The number of shares of Common Stock issued upon conversion of each share of Series A Preferred Stock shall be equal to the product of (i) the sum of (A) the Original Issue Amount plus (B) an amount equal to the cumulative amount of the accrued and unpaid dividends on such share at such time (regardless of whether or not declared or funds for their payment are lawfully available) divided by (ii) the Original Issue Amount, subject to adjustment as provided in the Certificate of Designations. /s/ Jeremy Blank 2023-03-13