0001515156-23-000103.txt : 20230724
0001515156-23-000103.hdr.sgml : 20230724
20230724185657
ACCESSION NUMBER: 0001515156-23-000103
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230720
FILED AS OF DATE: 20230724
DATE AS OF CHANGE: 20230724
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: 231106088
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
wk-form4_1690239409.xml
FORM 4
X0508
4
2023-07-20
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
0
Series A Convertible Preferred Stock
2023-07-20
4
D
0
747196
0
D
0
I
By YGF 100 LP.
Series A Convertible Preferred Stock
2023-07-20
4
D
0
23466
0
D
0
I
By Community SPV GP LP.
Common Stock
2023-07-20
4
A
0
747196
0
A
1855388
I
By YGF 100 LP.
Common Stock
2023-07-20
4
A
0
23466
0
A
43270
I
By Community SPV GP LP.
The shares of Series A Convertible Preferred Stock converted to an equal number of shares of the Issuer's Common Stock upon the 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 Convertible Preferred Stock.
This amount includes 9,539 shares of Series A Convertible Preferred Stock received on April 21, 2023, as dividends paid in-kind for the first quarter of 2023, which acquisition was exempt from Section 16 of the Securities Exchange Act of 1934, as amended, pursuant to Rule 16a-9 thereunder.
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.
This amount includes 300 shares of Series A Convertible Preferred Stock received on April 21, 2023, as dividends paid in-kind for the first quarter of 2023, which acquisition was exempt from Section 16 of the Securities Exchange Act of 1934, as amended, pursuant to Rule 16a-9 thereunder.
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.
/s/ Jeremy Blank
2023-07-24