SEC Form 4 · accession 0001655020-18-000117
Extraction Oil & Gas, Inc. · XOG
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Erickson
Officer — Chairman and CEO · Director
Period of report
Oct 17, 2018
Accepted (ET)
Oct 19, 2018 · 4:21 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001655020
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| COMMON STOCK | Oct 17, 2018 | F | 54,976 | $10.81 | D | 1,464,730 | D | |
| COMMON STOCK | holding | — | — | — | 271,956 | I | By wife | |
| COMMON STOCKF1 | holding | — | — | — | 1,231,995 | I | See Footnote (1) | |
| COMMON STOCKF2 | holding | — | — | — | 271,957 | I | See Footnote (2) | |
| COMMON STOCKF3 | holding | — | — | — | 2,046,449 | I | See Footnote (3) | |
| COMMON STOCKF4 | holding | — | — | — | 81 | I | See Footnote (4) |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1These shares are owned by Extraction Employee Incentive, LLC, an entity in which the reporting person owns a membership interest. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any. Pursuant to Rule 16a-1(a)(4) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), this filing shall not be deemed an admission that the Reporting Person is, for purposes of Section 16 of the Exchange Act or otherwise, the beneficial owners of any equity securities in excess of their respective pecuniary interests.
- F2These shares are owned by JME Investment Properties 2016, LLC, of which Jane M. Erickson, Mr. Erickson's wife, holds the managing interest through her sole ownership of Class A Membership Interests in JME Investment Properties 2016, LLC. The Jane M. Erickson 2016 Grantor Retained Annuity Trust, of which Ms. Erickson is Trustee, owns a 75% non-managing interest in JME Investment Properties 2016, LLC.
- F3These shares are owned by MAE Investment Properties 2016, LLC, of which Mr. Erickson holds the managing interest through his sole ownership of Class A Membership Interests in MAE Investment Properties 2016, LLC. The Mark A. Erickson 2016 Grantor Retained Annuity Trust, of which Mr. Erickson is Trustee, owns a 75% non-managing interest in MAE Investment Properties 2016, LLC.
- F4These shares are owned by MAE Holdings 2011 LLC. MAE Holdings 2011 LLC is an entity owned by Mr. Erickson.