SEC Form 4 · accession 0001434842-16-000049
Forbes Energy Services Ltd. · FLSS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Travis H. Burris
Director
Period of report
Jan 1, 2016
Accepted (ET)
Jan 5, 2016 · 11:38 am EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001434842
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jan 1, 2016 | M | 10,584 | $0.00 | A | 110,950 | D | |
| Common StockF1 | Jan 1, 2016 | D | 10,584 | $0.29 | D | 100,366 | D | |
| Common StockF2 | holding | — | — | — | 450 | I | By son |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Restricted Stock UnitsF1,F4,F3 | — | Jan 1, 2016 | M | 10,584 | D | — | — | Common Stock | 10,584 | 10,584 | D |
Explanation of responses
- F1On January 1, 2016, the reporting person had an award of restricted stock units that vested in accordance with the provisions in a grant made on June 15, 2015. Each restricted stock unit converts into common stock on a one-for-one basis. The restricted stock units were settled in cash valued at $0.29 per share, based on the market closing price on December 31, 2015. No shares were actually, issued, converted, or sold in connection with this transaction.
- F2The Reporting Person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for the purposes of Section 16 or for any other purpose.
- F3On June 15, 2015, the reporting person was granted 42,336 resticted stock units, vesting quarterly in four equal installments beginning on July 1, 2015
- F4This amount reflects a correction made to the total amount of derivate securities beneficially owned by the reporting person in the reporting person's Form 4 filed on October 5, 2015. The total amount of derivate securities beneficially owned by the reporting person disclosed in the Form 4 filed on October 5, 2015 was inadvertently incorrect because a transposition error. The number of derivative securities disposed of in the reporting person's Form 4 filed on October 5, 2015 should have been 10,584 and not 10,854.