Initial Statement of Beneficial Ownership (3)
June 27 2016 - 1:49PM
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
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Spence Nicholas
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2. Date of Event Requiring Statement (MM/DD/YYYY)
6/22/2016
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3. Issuer Name
and
Ticker or Trading Symbol
SYNERGY RESOURCES Corp [SYRG]
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(Last)
(First)
(Middle)
1625 BROADWAY, SUITE 300
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
Chief Operating Officer-Dev /
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(Street)
DENVER, CO 80202
(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)
_
X
_ Form filed by One Reporting Person
___ 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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82763
(1)
(2)
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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. 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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Non-Qualified Stock Option
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10/5/2016
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10/5/2025
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Common Stock
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100000.0
(3)
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$11.35
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D
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Performance Share Units
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(4)
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12/31/2018
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Common Stock
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25493.0
(5)
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$0.0
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D
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Explanation of Responses:
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(
1)
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Includes a grant of 50,000 restricted stock units ("RSUs"). The RSUs vest in equal amounts over 5 years beginning on the grant anniversary date, October 5, 2016 provided that the recipient continues to provide substantial services to the Company or an affiliate continuously through the applicable vesting dates.
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(
2)
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Includes a grant of 17,763 restricted stock units ("RSUs"). The RSUs vest 33% on March 30, 2017; 33% on March 30, 2018; and 34% on March 30, 2019, provided that the recipient continues to provide substantial services to the Company or an affiliate continuously through the applicable vesting dates. The number of RSU's granted is based on the five-day average closing price of the Company's common stock, as reported by the NYSE MKT, for the period ending March 30, 2016 (being $7.60 per share)
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(
3)
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Options to vest 20% on October 5, 2016, 20% on October 5, 2017, 20% on October 5, 2018, 20% on October 5, 2019 and 20% on October 5, 2020.
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(
4)
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The number of Performance Share Units granted is based on the five-day average closing price of the Company's common stock, as reported by the NYSE MKT, for the period ending March 30, 2016 (being $7.60 per share).
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(
5)
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The reporting person will vest in 0% - 200% of the Performance Share Units based on the relative Total Shareholder Return (TSR) of the Company between January 1, 2016 and December 31, 2018, as measured against the TSR of certain peer companies over that period, provided that the recipient continues to provide substantial services to the Company or an affiliate continuously from the grant date through December 31, 2018.
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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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Spence Nicholas
1625 BROADWAY
SUITE 300
DENVER, CO 80202
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Chief Operating Officer-Dev
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Signatures
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Cathleen M. Osborn, Attorney-in-Fact
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6/27/2016
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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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