SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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).
  
Form 3 Holdings Reported.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Heyman Stephen J

(Last) (First) (Middle)
15 EAST 5TH STREET, SUITE 3200

(Street)
TULSA OK 74103

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
SCOTTS LIQUID GOLD INC [ SLGD ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2011
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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 at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 03/14/2011 S4 88,000 D $0.2498 338,608 I Boston Avenue Capital LLC(1)
Common Stock 03/15/2011 S4 23,000 D $0.25 338,608 I Boston Avenue Capital LLC(1)
Common Stock 03/18/2011 S4 6,000 D $0.26 338,608 I Boston Avenue Capital LLC(1)
Common Stock 1,122,922 I Yorktown Avenue Capital, LLC(1)
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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
Heyman Stephen J

(Last) (First) (Middle)
15 EAST 5TH STREET, SUITE 3200

(Street)
TULSA OK 74103

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
Adelson James F

(Last) (First) (Middle)
15 EAST 5TH STREET, SUITE 3200

(Street)
TULSA OK 74103

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
Gillman Charles M

(Last) (First) (Middle)
15 EAST 5TH STREET-SUITE 3200

(Street)
TULSA OK 74103

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. Each of Boston Avenue Capital LLC ("Boston") and Yorktown Avenue Capital, LLC ("Yorktown"), directly beneficially owns and has voting and dispositive powers over their respective shares of the reported securities. Stephen J. Heyman and James F. Adelson (as the sole Managers of Boston and Yorktown), and Charles M. Gillman (as the portfolio manager of Boston and Yorktown), have the power to vote or direct the vote of (and the power to dispose or direct the disposition of) any shares of Common Stock beneficially owned by Boston and Yorktown, and may each be deemed to be an indirect owner of the reported securities. Messrs. Heyman, Adelson, and Gillman disclaim beneficial ownership of the reported securities except to the extent of their pecuniary interests therein.
Remarks:
This is a joint filing with Mr. Stephen J. Heyman as the designated filer. Also included in this filing are Mr. James F. Adelson and Mr. Charles M. Gillman.
Paula L. Skidmore, Attorney-in-Fact for the Reporting Persons 04/03/2013
** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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