Statement of Changes in Beneficial Ownership (4)
September 01 2021 - 07:52PM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
|
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
1. Name
and Address of Reporting Person * SIEM IVAR |
2. Issuer Name and Ticker or Trading
Symbol PEDEVCO CORP [ PED ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
|
(Last)
(First)
(Middle)
575 N. DAIRY ASHFORD, ENERGY CENTER II, SUITE 210 |
3. Date of Earliest Transaction (MM/DD/YYYY)
9/1/2021
|
(Street)
HOUSTON, TX 77079
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line) _X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
9/1/2021 |
|
A |
|
70000 (1) |
A |
$1.15 (2) |
155000 |
D |
|
Common Stock |
|
|
|
|
|
|
|
187100 |
I |
American Resources Inc. (3) |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of derivative Securities Beneficially
Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of
Responses: |
(1) |
The shares of Restricted
Common Stock were issued to the Reporting Person pursuant to
Issuer's 2012 Equity Incentive Plan and are subject to forfeiture.
The shares fully vest on July 12, 2022, subject to the Reporting
Person being a member of the Issuer's Board of Directors on such
vesting date, and subject to the terms and conditions of a
Restricted Shares Grant Agreement entered into by and between the
Issuer and the Reporting Person. Exempt under Rule
16b-3(d). |
(2) |
Issued to the Reporting
Person in consideration for services rendered and agreed to be
rendered as a member of the Board of Directors of the
Issuer. |
(3) |
The reporting person
disclaims beneficial ownership of the reported securities held by
American Resources Offshore Inc., except to the extent of his
pecuniary interest therein, and the inclusion of these securities
in this report shall not be deemed an admission of beneficial
ownership for purposes of Section 16 or for any other
purpose. |
Remarks:
See Power of Attorney filed as Exhibit 24.1 to the Form 4 filed by
the Reporting Person on August 29, 2019. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
SIEM IVAR
575 N. DAIRY ASHFORD
ENERGY CENTER II, SUITE 210
HOUSTON, TX 77079 |
X |
|
|
|
Signatures
|
/s/ Clark R. Moore, attorney-in-fact for Ivar
Siem |
|
9/1/2021 |
**Signature of
Reporting Person |
Date |
PEDEVCO (AMEX:PED)
Historical Stock Chart
From Apr 2022 to May 2022
PEDEVCO (AMEX:PED)
Historical Stock Chart
From May 2021 to May 2022