Statement of Changes in Beneficial Ownership (4)
March 05 2019 - 4:56PM
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
*
Cooper L Melvin
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2. Issuer Name
and
Ticker or Trading Symbol
Forbes Energy Services Ltd.
[
FLSS
]
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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)
Senior Vice President & CFO
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(Last)
(First)
(Middle)
3000 SOUTH BUSINESS HIGHWAY 281
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3. Date of Earliest Transaction
(MM/DD/YYYY)
3/1/2019
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(Street)
ALICE, TX 77382
(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)
_
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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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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Restricted Stock Units
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(1)
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3/1/2019
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(1)
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A
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4390
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(2)
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(2)
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Common Stock, par value $0.01
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4390.0
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$0
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2634
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D
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Restricted Stock Units
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(3)
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3/1/2019
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M
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1756
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(3)
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(3)
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Common Stock, par value $0.01
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1756.0
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$0
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1756
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D
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Explanation of Responses:
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(1)
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Each restricted stock unit represents a contingent right to receive one share of Company common stock, par value $0.01 per share.
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(2)
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Represents the total number of exit financing restricted stock units granted on August 28, 2017 under the Company's management incentive plan. The number of restricted stock units that are ultimately earned is determined by the date on which a debt repayment condition is met as described in the Company's management incentive plan. The number of restricted stock units that are ultimately earned vest as follows: 40% on the first day following the date that is eighteen (18) months after the date of grant, 20% each on the second and third anniversaries of the date of grant, and 20% one day prior to the fourth anniversary of the date of grant. The restricted stock units, once vested, will generally entitle the Reporting Person to receive the applicable number of shares of Company common stock.
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(3)
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Represents the maximum number of vested restricted stock units for which shares could be issued in accordance with the provisions of the grant made on August 28, 2017.
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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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Cooper L Melvin
3000 SOUTH BUSINESS HIGHWAY 281
ALICE, TX 77382
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Senior Vice President & CFO
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Signatures
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/s/ L. Melvin Cooper
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3/5/2019
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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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