SEC Form 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|C/O GREAT ELM CAPITAL CORP.|
|800 SOUTH STREET, SUITE 230, WALTHAM, MA|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
Great Elm Capital Corp.
[ GECC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
|Chief Compliance Officer||
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||Form filed by One Reporting Person
||Form filed by More than One Reporting Person
|Table I - Non-Derivative Securities Beneficially Owned|
|1. Title of Security (Instr.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
||By Mast Admiral Master Fund L.P.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
||/s/ Richard S. Chernicoff as Attorney-in-Fact for Reporting Person
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
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.|
GREAT ELM CAPITAL CORP.
LIMITED POWER OF ATTORNEY FOR REPORTING UNDER SECTION 16(a) OF THE SECURITIES
EXCHANGE ACT OF 1934, AS AMENDED
Know all by these presents, that the undersigned hereby constitutes and appoints
the officers of Great Elm Capital Corp. and Great Elm Capital Management, Inc.,
signing singly, the undersigned's true and lawful attorney-in-fact to:
(a) execute for and on behalf of the undersigned, in the undersigned's
capacity as director of Great Elm Capital Corp. or any of its portfolio
company investments filings required under Section 16(a) of the Securities
Exchange Act of 1934, as amended, and the rules thereunder (the "Exchange
(b) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Exchange
Act filings, complete and execute any amendment or amendments thereto, and
timely file any such form with the United States Securities and Exchange
Commission and any stock exchange or similar authority, including
completing and executing a Uniform Application for Access Codes to File on
Edgar on Form ID; and
(c) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such
attorney-in-fact, may be of
benefit to, in the best interest of, or legally required by, the
undersigned, it being understood that the documents executed by such
attorney-in-fact on behalf of the undersigned pursuant to this Power of
Attorney shall be in such form and shall contain such terms and conditions
as such attorney-in-fact may approve in such attorney-in-fact's
The undersigned hereby grants to each attorney-in-fact full power and authority
to do and perform any and every act and thing whatsoever requisite, necessary,
or proper to be done in the exercise of any of the rights and powers herein
granted, as fully to all intents and purposes as the undersigned might or could
do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such attorney-in-fact, or such attorney-in-
fact's substitute or substitutes, shall lawfully do or cause to be done by
virtue of this power of attorney and the rights and powers herein granted. The
undersigned acknowledges that the foregoing attorneys- in-fact, in serving in
such capacity at the request of the undersigned, are not assuming, any of the
undersigned's responsibilities to comply with Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to make filings under the Exchange Act with
respect to Great Elm Capital Corp. or any of its portfolio companies, the
undersigned is no longer a director of Great Elm Capital Corp., or unless
earlier revoked by the undersigned in a signed writing delivered to an officer
of Great Elm Capital Corp.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 4th day of October 2017.
/s/ Adam M. Kleinman
Adam M. Kleinman