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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Forge Energy, LLC 15727 ANTHEM PARKWAY, SUITE 501 SAN ANTONIO, TX 78249 |
Former 10% Owner |
Forge Energy, LLC, /s/ Barry J. Winstead, President & CEO | 06/13/2018 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Pursuant to the company agreement of the Reporting Person, on June 11, 2018, the Reporting Person made a distribution of the securities of the Issuer to its sole member, Forge Energy Holdings, LLC ("Forge Energy Holdings"). Pursuant to the company agreement of Forge Energy Holdings, on the same date, Forge Energy Holdings made a pro rata distribution of the securities of the issuer to all of its members. |
(2) | All such shares remain held in escrow by Citibank, National Association ("Citibank") for the benefit of the Reporting Person pursuant to that certain Indemnity Escrow Agreement, dated February 12, 2018, by and among the Reporting Person, Oasis Petroleum Permian LLC and Citibank. |
(3) | The Reporting Person disclaims beneficial ownership of the reported securities except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the reported securities for purposes of Section 16 or for any other purpose. |
Remarks: As a result of its distribution of the Issuer's securities on June 11, 2018, the Reporting Person is no longer considered a 10% beneficial owner of any class of the securities of the Issuer. Therefore the Reporting Person is no longer subject to Section 16 of the Exchange Act of 1934 and will no longer report transactions in any such securities on Form 4 or Form 5. |