SEC Form 4 · accession 0001065949-15-000002
THREE FORKS, INC.
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Period of report
Nov 27, 2014
Accepted (ET)
Jan 6, 2015 · 2:19 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001548082
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| OptionF1 | $0.10 | Nov 27, 2014 | J | 1,750,000 | D | — | — | Common Stock | 1,750,000 | 500,000 | D |
| OptionF2 | $1.00 | Nov 27, 2014 | J | 50,000 | D | — | — | Common Stock | 50,000 | 0 | D |
Explanation of responses
- F1Mr. Pollard surrendered to the Company 1,750,000 of the $0.10 Options issued to him for immediate cancellation by the Company in connection with the Resignation and Settlement Agreement dated 11/27/2014.
- F2Mr. Pollard surrendered to the Company 50,000 of the $1.00 Options issued to him for immediate cancellation by the Company in connection with the Resignation and Settlement Agreement dated 11/27/2014.