Amended Statement of Changes in Beneficial Ownership (4/a)
January 10 2017 - 5:11PM
Edgar (US Regulatory)
FORM 4
[ ]
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
*
Ninke David
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2. Issuer Name
and
Ticker or Trading Symbol
Samson Oil & Gas LTD
[
SSN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
VP - Exploration
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(Last)
(First)
(Middle)
C/O SAMSON OIL & GAS LIMITED, 1331 17TH STREET, SUITE 710
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3. Date of Earliest Transaction
(MM/DD/YYYY)
11/30/2016
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(Street)
DENVER, CO 80202
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
12/2/2016
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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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Ordinary Shares
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11/30/2016
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A
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9969000
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A
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$0.0032
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12081400
(1)
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D
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Ordinary Shares
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11/30/2016
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F
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3267000
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D
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$0.0032
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8814400
(1)
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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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Options to Purchase Ordinary Shares
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$0.0041
(2)
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11/30/2016
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A
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35000000
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(3)
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11/16/2026
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Ordinary Shares
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35000000
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$0
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35000000
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D
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Explanation of Responses:
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(
1)
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Amount reported in Box 5 reflects ordinary shares owned following the change in the exchange ratio of the Issuer's American Depositary Shares ("ADS") as reported on the Issuer's Current Report on Form 8-K filed with the Securities and Exchange Commission on March 30, 2015. After the change in the exchange ratio, the resulting reduction in issued and outstanding ADS and the elimination of fractional shares resulting therefrom, the Reporting Party beneficially owns 10,562 ADS.
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(
2)
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The exercise price is priced in Australian dollars. This is the U.S. dollar equivalent of the price of A$0.0055 using the rate of exchange published by the Reserve Bank of Australia for December 1, 2016 (A$1.00=US$0.7408).
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(
3)
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The options will fully vest and become exercisable on 11/16/2017 if the Reporting Person has been continuously employed by the Registrant in his current position on that date.
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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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Ninke David
C/O SAMSON OIL & GAS LIMITED
1331 17TH STREET, SUITE 710
DENVER, CO 80202
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VP - Exploration
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Signatures
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/s/ David Ninke
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1/10/2017
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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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