# EDGAR Filing Document

**Accession Number:** 0001515156
**File Stem:** 0001515156-23-000013
**Filing Date:** 2023-2
**Character Count:** 6935
**Document Hash:** 3ba2fe7003a710d1571f5ce6d1ad23ca
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001515156-23-000013.hdr.sgml**: 20230203

**ACCESSION NUMBER**: 0001515156-23-000013

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230201

**FILED AS OF DATE**: 20230203

**DATE AS OF CHANGE**: 20230203

**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:** 23587894

**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

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Blank Jeremy<br><sub>(Last) (First) (Middle)</sub><br>C/O ADVANCED EMISSIONS SOLUTIONS, INC.<br>8051 E. MAPLEWOOD AVENUE, SUITE 210<br><sub>(Street)</sub><br>GREENWOOD VILLAGE, CO 80111<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-01 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Advanced Emissions Solutions, Inc. [ ADES ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2023-02-01 |  | P |  | 631866 | A | $4 | 631866 | I | See footnote.<sup>(1)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Warrants (right to buy) | $0.01 | 2023-02-01 |  | J<sup>(2)</sup> |  | 1 |  | 2023-02-01 | 2030-02-01 | Common Stock | 325457.0 | <sup>(2)</sup> | 1 | I | See footnote.<sup>(2)</sup> |

---

### Footnotes:

(1) The shares reported on this row are held by YGF 100 LP.  Jeremy Blank, a Director of the Issuer, is the general partner of YGF 100 LP.  Mr. Blank is an investor in YGF 100 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.

(2) The warrant reported on this row (the "Warrant") was issued by the Issuer to CF Global Credit, LP in connection with that certain Term Loan and Security Agreement, dated as of February 1, 2023 (the "Loan Agreement") and as consideration for the term loan pursuant to the Loan Agreement.  The Warrant has an exercise price of $0.01 per share, subject to adjustment as set forth in the Warrant, is exercisable immediately and will expire on February 1, 2030.  The terms of the Warrant do not allow for cash exercise and the Warrant may only be exercised pursuant to the terms thereof.  Mr. Blank controls the general partner of CF Global Credit, LP.  Mr. Blank is an investor in CF Global Credit, LP and therefore is an indirect beneficial owner of a portion of the shares underlying the Warrant.  Mr. Blank disclaims beneficial ownership of the shares underlying the Warrant except to the extent of his pecuniary interest therein.

**Signature:** /s/ Jeremy Blank  
**Date:** 2023-02-03

### Remarks:

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.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**