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