SEC Form 4 · accession 0001006655-16-000126
EVOLUTION PETROLEUM CORP · EPM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Randall D Keys
Officer — President and CEO
Period of report
Sep 1, 2016
Accepted (ET)
Sep 6, 2016 · 5:48 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001006655
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Sep 1, 2016 | F | 22,543 | $5.67 | D | 190,597 | D | |
| Common StockF2 | Sep 1, 2016 | A | 87,302 | $5.67 | A | 277,899 | D | |
| Common StockF3 | Sep 1, 2016 | M | 12,931 | $5.67 | A | 290,830 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Contingent Performance Stock GrantF3 | $0.00 | Sep 1, 2016 | M | 12,931 | D | — | Dec 4, 2019 | Common Stock | 12,931 | 12,931 | D |
| Contingent Performance Stock GrantF2 | $0.00 | Sep 1, 2016 | A | 29,101 | A | — | Sep 1, 2020 | Common Stock | 29,101 | 29,101 | D |
Explanation of responses
- F1Shares surrendered to the Company to pay income tax withholding obligations.
- F2The Company granted these shares of restricted stock pursuant to the Company's Amended and Restated 2004 Stock Plan, subject to specific performance goals and other vesting criteria.
- F3Contingent Restricted Stock award granted on December 4, 2015 that vested upon attainment of a specific performance goal.