Initial Statement of Beneficial Ownership (3)
September 13 2019 - 4:53PM
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
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3235-0104
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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
*
Foschi Marianella |
2. Date of Event Requiring Statement (MM/DD/YYYY)
9/4/2019
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3. Issuer Name and Ticker or Trading Symbol
Extraction Oil & Gas, Inc. [XOG]
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(Last)
(First)
(Middle)
C/O EXTRACTION OIL & GAS, INC., 370 17TH STREET #5300 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Vice President, Finance / |
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(Street)
DENVER, CO 80202
(City)
(State)
(Zip)
| 5. 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
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4) | 2. Amount of Securities Beneficially Owned
(Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) | 4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| COMMON STOCK | 114481 | D | |
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) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) | 6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Explanation of Responses: |
Remarks:
1. Includes (i) an award of 30,976 unvested restricted stock units, with 25% vesting on each of April 1, 2020 and 2021 and 50% vesting on April 1, 2022, (ii) an award of 22,500 unvested restricted stock units, with 7,500 vesting on March 1, 2020 and 15,000 vesting on March 1, 2021, (iii) an award of 15,000 unvested restricted stock units, with 7,500 vesting on September 15, 2019 and 7,500 vesting on March 15, 2020 and (iv) an award of 37,500 unvested restricted stock units vesting on October 17, 2019, all subject to continued service through each vesting date, and will be settled in shares of common stock.
See attached for Exhibit 24 - Power of Attorney |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Foschi Marianella
C/O EXTRACTION OIL & GAS, INC.
370 17TH STREET #5300
DENVER, CO 80202 |
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| Vice President, Finance |
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Signatures
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| /s/ Eric J. Christ, Attorney-in-Fact | | 9/13/2019 |
| **Signature of Reporting Person | Date |
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