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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Olmstead Jeffrey R. 2431 E. 61ST ST., SUITE 850 TULSA, OK 74136 |
X | President and CFO |
/s/ Richard M. Carson, Attorney-in-fact | 12/22/2011 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Pursuant to the Contribution, Conveyance, Assumption and Merger Agreement entered into by the Reporting Person, Mid-Con Energy Partners, LP (the "Issuer") and the other parties thereto, the Reporting Person received 65,232 common units of the Issuer and a cash payment as consideration for the merger of Mid-Con Energy I, LLC and Mid-Con Energy II, LLC with and into Mid-Con Energy Properties, LLC, a wholly-owned subsidiary of the Issuer, which occurred in connection with the closing of the Issuer's inital public offering on December 20, 2011. |
(2) | The Charles R. Olmstead 2011 Trust received 105,097 common units of the Issuer in connection with the merger referenced in footnote 1. The reporting person is a trustee of the Charles R. Olmstead 2011 Trust and has immediate family members who are beneficiaries of the trust. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. |