Statement of Changes in Beneficial Ownership (4)
November 03 2014 - 12:43PM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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KOVALEVA TATIANA
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2. Issuer Name
and
Ticker or Trading Symbol
Park Place Energy Corp.
[
PKPL
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
_____ Officer (give title below)
__
X
__ Other (specify below)
Former Treasurer
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(Last)
(First)
(Middle)
408 - 1003 PACIFIC STREET
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3. Date of Earliest Transaction
(MM/DD/YYYY)
10/27/2014
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(Street)
VANCOUVER, A1 V6E 4P2
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Shares
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10/27/2014
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M
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9750
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A
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$0.51
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9750
(3)
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Restricted Stock Units
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(1)
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8/31/2014
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(2)
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Common Shares
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15000
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15000
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D
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Restricted Stock Units
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$0.51
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10/27/2014
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M
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15000
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8/31/2014
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(2)
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Common Shares
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9750
(3)
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$0.51
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0
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D
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Explanation of Responses:
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(
1)
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Each Restricted Stock Unit is a notional share of common shares of the Issuer, with a value of each Unit being equal to the Fair Market Value of a share of common stock at any time.
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(
2)
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100% of the total Restricted Stock Units shall vest on August 31, 2014 and will convert within 30 days of August 31, 2014, provided Ms. Kovaleva is still a contractor providing services to the Issuer on that date. Ms. Kovaleva resigned as the Issuer's Treasurer on September 15, 2014.
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(
3)
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The Issuer withheld 35% of the vested shares, which is 5,250 shares and paid Ms. Kovaleva a cash amount equal to 110% of the Fair Market Value of the withheld vested shares, which was determined using the closing price of the Issuer's common stock on the last trading day prior to the vesting date (August 29, 2014). The Fair Market Value of such shares was $2,677.50 (5,250 times $0.51), and the cash amount paid to Ms. Kovaleva was $2,945.25 (110% times $2,677.50). The Issuer also issued 9,750 common shares to Ms. Kovaleva. The intent of withholding 35% of the vested shares was to provide Ms. Kovaleva with cash to assist in the payment of taxes owing as a result of the award.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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KOVALEVA TATIANA
408 - 1003 PACIFIC STREET
VANCOUVER, A1 V6E 4P2
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Former Treasurer
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Signatures
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/s/ Tatiana Kovaleva
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10/31/2014
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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