SEC Form 4 · accession 0001615774-17-000010

GlyEco, Inc. · GLYE

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Scott P Nussbaum

Director

Period of report

Dec 27, 2016

Accepted (ET)

Jan 4, 2017 · 8:22 am EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000931799

Table I — non-derivative securities

No Table I lines on this filing.

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Common Stock Purchase Warrant^F4	$0.08	Dec 27, 2016	P	156,250	A	Dec 27, 2016	Dec 27, 2019	Common Stock	156,250	156,250	D
Common Stock Purchase Warrant^F5,F2	$0.08	Dec 27, 2016	P	312,500	A	Dec 27, 2016	Dec 27, 2019	Common Stock	312,500	312,500	I
Common Stock Purchase Warrant^F6,F3	$0.08	Dec 27, 2016	P	156,250	A	Dec 27, 2016	Dec 27, 2019	Common Stock	156,250	156,250	I

Explanation of responses

F1These warrants were issued in connection with an issuance of 8% Senior Unsecured Promissory Notes and warrants to purchase common stock by the Issuer on December 27, 2016.
F2Held by a trust of which the reporting person's spouse is a beneficiary. The reporting person expressly disclaims beneficial ownership of all securities held by the trust.
F3Held by a trust of which the reporting person's sister is a beneficiary, and of which the reporting person is a trustee.
F4A Common Stock Purchase Warrant entitling the Reporting Person to acquire an aggregate of 156,250 shares of the Issuer's Common Stock at an exercise price of $.08 per share was acquired by the Reporting Person as additional consideration pursuant to the December 27, 2016 Securities Purchase Agreement between the Reporting Person and the Issuer. No monetary value was ascribed to the warrant.
F5A Common Stock Purchase Warrant entitling a trust affiliated with the Reporting Person to acquire an aggregate of 312,500 shares of the Issuer's Common Stock at an exercise price of $.08 per share was acquired by the Reporting Person as additional consideration pursuant to the December 27, 2016 Securities Purchase Agreement between the Reporting Person and the Issuer. No monetary value was ascribed to the warrant.
F6A Common Stock Purchase Warrant entitling the Reporting Person to acquire an aggregate of 156,250 shares of the Issuer's Common Stock at an exercise price of $.08 per share was acquired by the Reporting Person as additional consideration pursuant to the December 27, 2016 Securities Purchase Agreement between the Reporting Person and the Issuer. No monetary value was ascribed to the warrant.