EX-4.1 5 brhc10018388_ex4-1.htm EXHIBIT 4.1
Exhibit 4.1

 
COMMON STOCK
   
COMMON STOCK
   
 
PAR VALUE $0.001
   
THIS CERTIFICATE IS
TRANSFERABLE IN
CANTON, MA, JERSEY
CITY, NJ AND COLLEGE
STATION, TX
   
Certificate Number
ZQ00000000
 
GREAT ELM GROUP, INC.
INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE
     
SHARES
**000000******************
***000000*****************
****000000****************
*****000000***************
******000000**************
THIS CERTIFIES THAT  
MR. SAMPLE & MRS. SAMPLE & MR. SAMPLE & MRS SAMPLE
  CUSIP 39037G 109    
 
SEE REVERSE FOR
CERTAIN DEFINITIONS
 
is the owner of
 
***ZERO HUNDRED THOUSAND ZERO HUNDRED AND ZERO***
       
 
FULLY-PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK OF
   
GREAT ELM GROUP, INC. (hereinafter called the “Company”), transferrable on the books of the Company in person or by duly authorized attorney, upon surrender of this Certificate properly endorsed.  This Certificate and the shares represented hereby, are issued and shall be held subject to all of the provisions of the Articles of Incorporation, as amended, and the Bylaws, as amended, of the Company (copies of which are on file with the Company and with the Transfer Agent), to all of which each holder, by acceptance hereof, assents.  This Certificate is not valid unless countersigned and registered by the Transfer Agent and Registrar.
Witness the facsimile seal of the Company and the facsimile signatures of its duly authorized officers.
[Signature]
DATED
DD-MMM-YYYY
COUNTERSIGNED AND REGISTERED:
COMPUTERSHARE INC.
TRANSFER AGENT AND REGISTRAR,
Chief Executive Officer
 
 
By:
 
 
AUTHORIZED SIGNATURE
 
SECURITY INSTRUCTIONS ON REVERSE
 


 
CUSIP
XXXXXX XX X
HOLDER ID
XXXXXXXXXX
INSURANCE VALUE
1,000,000.00
NUMBER OF SHARES
123456
DTC
12345678 123456789012345
PO BOX 43004, Providence, RI 02940-3004
 
 
Certificate Numbers
Num/No.
Denom.
Total
MR A SAMPLE
1234567890/1234567890
1
1
1
DESIGNATION (IF ANY)
1234567890/1234567890
2
2
2
ADD 1
1234567890/1234567890
3
3
3
ADD 2
1234567890/1234567890
4
4
4
ADD 3
1234567890/1234567890
5
5
5
ADD 4
1234567890/1234567890
6
6
6
 
Total Transaction
   
7


GREAT ELM GROUP, INC.

This certificate also evidences and entitles the holder hereof to certain Rights as set forth in a Stockholders’ Rights Agreement between Great Elm Group, Inc. and Computershare Trust Company, N.A. (or any successor thereto), as Rights Agent, dated as of December 29, 2020 as amended, restated, renewed, supplemented or extended from time to time (the “Rights Agreement”), the terms of which are hereby incorporated herein by reference and a copy of which is on file at the principal offices of Great Elm Group, Inc. and the office or offices of the Rights Agent designated for such purpose. Under certain circumstances, as set forth in the Rights Agreement, such Rights will be evidenced by separate certificates and will no longer be evidenced by this certificate. Great Elm Group, Inc. may redeem the Rights at a redemption price of $0.001 per Right, subject to adjustment, under the terms of the Rights Agreement. Great Elm Group, Inc. will mail to the holder of this certificate a copy of the Rights Agreement, as in effect on the date of mailing, without charge promptly after receipt of a written request therefor. Under certain circumstances, Rights issued to or held by Acquiring Persons or any Affiliates or Associates thereof (as defined in the Rights Agreement), and any subsequent holder of such Rights, may become null and void. The Rights shall not be exercisable, and shall be void so long as held, by a holder in any jurisdiction where the requisite qualification, if any, to the issuance to such holder, or the exercise by such holder, of the Rights in such jurisdiction shall not have been obtained or be obtainable.

The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations:
             
TEN COM - as tenants in common  
UNIF GIFT MIN ACT
-
Custodian
TEN ENT - as tenants by the entireties  
 
  (Cust.) (Minor)
JT ENT - as joint tenants with right of survivorship and not as tenants in common      
under Uniform Gifts to Minors Act
           
(State)
     
UNIF TRF MIN ACT
-
Custodian (until age)
          (Cust.)  
          under Uniform Transfers to Minors Act 
          (Minor) (State)
Additional abbreviations may also be used though not in the above list.


THE COMPANY WILL FURNISH WITHOUT CHARGE TO EACH SHAREHOLDER WHO SO REQUESTS, A SUMMARY OF THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE, PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OF THE COMPANY AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND RIGHTS, AND THE VARIATIONS IN RIGHTS, PREFERENCES AND LIMITATIONS DETERMINED FOR EACH SERIES, WHICH ARE FIXED BY THE ARTICLES OF INCORPORATION OF THE COMPANY, AS AMENDED, AND THE RESOLUTIONS OF THE BOARD OF DIRECTORS OF THE COMPANY, AND THE AUTHORITY OF THE BOARD OF DIRECTORS TO DETERMINE VARIATIONS FOR FUTURE SERIES.  SUCH REQUEST MAY BE MADE TO THE OFFICE OF THE SECRETARY OF THE COMPANY OR TO THE TRANSFER AGENT.  THE BOARD OF DIRECTORS MAY REQUIRE THE OWNER OF A LOST OR DESTROYED STOCK CERTIFICATE, OR HIS LEGAL REPRESENTATIVES, TO GIVE THE COMPANY A BOND TO INDEMNIFY IT AND ITS TRANSFER AGENTS AND REGISTRARS AGAINST ANY CLAIM THAT MAY BE MADE AGAINST THEM ON ACCOUNT OF THE ALLEGED LOSS OR DESTRUCTION OF ANY SUCH CERTIFICATE.
 
PLEASE INSERT SOCIAL SECURITY OR
OTHER IDENTIFYING NUMBER OF ASSIGNEE
For the value received,                                                                             hereby sell, assign and transfer unto                             
 
(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE, OF ASSIGNEE)
 
 

Shares
of the common stock represented by the within Certificate, and do hereby irrevocably constitute and appoint

Attorney
to transfer the said stock on the books of the within-named Company with full power of substitution in the premises.
 
Dated:
                                             20                      
 
Signature(s) Guaranteed:  Medallion Guarantee Stamp

THE SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions) WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO S.E.C. RULE 17Ad-15
   
Signature:

   
Signature:
 
   
Notice: 
The signature to the assignment must correspond with the name as written upon the face of the certificate, in every particular, without alteration or enlargement, or any change whatever.


SECURITY INSTRUCTIONS
 
THIS IS WATERMARKED PAPER.  DO NOT ACCEPT WITHOUT NOTING WATERMARK.  HOLD TO LIGHT TO VERIFY WATERMARK.
 
The IRS requires that we report, the cost basis of certain shares acquired after January 1, 2011.  If your shares were covered by the legislation and you have sold or transferred the shares and requested a specific cost basis calculation method, we have processed as requested.  If you did not specify a cost basis calculation method, we have defaulted the first in, first out (FIFO) method.  Please visit our website or consult your tax advisor if you need additional information about cost basis.

If you do not keep in contact with us or do not have any activity in your account for the time periods specified by the state law, your property could become subject to state unclaimed property laws and transferred to the appropriate state.
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