Initial Statement of Beneficial Ownership (3)
November 07 2016 - 6:13PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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
*
BAIN CAPITAL CREDIT MEMBER, LLC
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2. Date of Event Requiring Statement (MM/DD/YYYY)
10/26/2016
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3. Issuer Name
and
Ticker or Trading Symbol
Yuma Energy, Inc. [YUMA]
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(Last)
(First)
(Middle)
C/O BAIN CAPITAL CREDIT, LP, 200 CLARENDON STREET
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
___
X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
BOSTON, MA 02116
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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1607301
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I
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Bain Capital Credit Member, LLC ("BCCM) is the administrative member of Sankaty Davis, LLC ("Sankaty Davis"). As a result, BCCM may be deemed to share voting and dispositive power with respect to all of the shares of Common Stock held by Sankaty Davis. BCCM disclaims beneficial ownership of such securities except to the extent of its pecuniary interest therein.
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(
2)
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Reflects Sankaty Davis' beneficial ownership of shares of common stock of the Issuer after the reincorporation of Yuma Energy, Inc., a California corporation, to Delaware and the 1-for-20 reverse stock split.
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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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BAIN CAPITAL CREDIT MEMBER, LLC
C/O BAIN CAPITAL CREDIT, LP
200 CLARENDON STREET
BOSTON, MA 02116
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X
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Sankaty Davis, LLC
C/O BAIN CAPITAL CREDIT, LP
200 CLARENDON STREET
BOSTON, MA 02116
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X
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Signatures
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/s/ Bain Capital Credit Member, LLC
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11/7/2016
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**
Signature of Reporting Person
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Date
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/s/ Sankaty Davis, LLC
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11/7/2016
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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 5(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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