Statement of Changes in Beneficial Ownership (4)
September 30 2016 - 4:16PM
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
*
SemGroup Corp
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2. Issuer Name
and
Ticker or Trading Symbol
Rose Rock Midstream, L.P.
[
RRMS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
TWO WARREN PLACE, 6120 SOUTH YALE AVENUE, SUITE 700
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/30/2016
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(Street)
TULSA, OK 74136-4216
(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)
___ Form filed by One Reporting Person
_
X
_ 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 Units representing limited partner interests
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9/30/2016
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D
(1)
(2)
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20704418
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D
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(1)
(2)
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0
(1)
(2)
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I
(1)
(2)
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See Footnotes
(1)
(2)
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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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Explanation of Responses:
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(
1)
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On September 30, 2016, pursuant to that certain Agreement and Plan of Merger (the "Merger Agreement"), dated May 30, 2016, by and among SemGroup Corporation ("SemGroup"), PBMS, LLC ("Merger Sub"), Rose Rock Midstream, L.P. ("RRMS") and Rose Rock Midstream GP, LLC ("RRMS General Partner"), Merger Sub merged with and into RRMS with RRMS being the surviving entity in the merger (the "Merger"). On September 30, 2016, following the consummation of the Merger, SemGroup and certain of its subsidiaries commenced a series of transactions, including (i) the merger of RRMS with and into SemGroup, (ii) the merger of Rose Rock Midstream Holdings, LLC ("Holdings") with and into SemGroup and (iii) the merger of Rose Rock Midstream Corporation ("RRMC") with and into Holdings, (each a "Clean-up Merger" and, together, the "Clean-up Mergers"), with SemGroup, in the instance of clauses (i) and (ii), continuing as the surviving entity.
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(
2)
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(Continued from footnote 1) Upon the completion of the Clean-up Mergers, all RRMS Common Units previously owned by the Reporting Persons were disposed of and each of Holdings, RRMC and RRMS ceased to exist as separate legal entities.
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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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SemGroup Corp
TWO WARREN PLACE
6120 SOUTH YALE AVENUE, SUITE 700
TULSA, OK 74136-4216
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X
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X
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Rose Rock Midstream Holdings, LLC
TWO WARREN PLACE
6120 SOUTH YALE AVENUE, SUITE 700
TULSA, OK 74136-4216
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X
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X
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Rose Rock Midstream Corp
TWO WARREN PLACE
6120 SOUTH YALE AVENUE, SUITE 700
TULSA, OK 74136-4216
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X
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Signatures
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/s/ William H. Gault, Corporate Secretary of SemGroup Corporation
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9/30/2016
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**
Signature of Reporting Person
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Date
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/s/ William H. Gault, Secretary of Rose Rock Midstream Holdings, LLC
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9/30/2016
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**
Signature of Reporting Person
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Date
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/s/ William H. Gault, Secretary of Rose Rock Midstream Corporation
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9/30/2016
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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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Rose Rock Midstream, L.P. Common Units Representing Limited Partner Interests (NYSE:RRMS)
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