SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Montage Resources Corp [ MR ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 02/28/2019 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction 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 | 02/28/2019 | M | 11,825(1) | A | (1) | 62,745 | D | |||
Common Stock | 02/28/2019 | M | 18,449(2) | A | (2) | 81,194 | D | |||
Common Stock | 02/28/2019 | M | 5,518(3) | A | (3) | 86,712 | D | |||
Common Stock | 16,555 | I | See footnote(4) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 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: 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 | ||||||||
Performance Stock Unit | (1) | 02/28/2019 | M | 11,825 | (1) | (1) | Common Stock | 11,825 | $0.00 | 0 | D | ||||
Performance Stock Unit | (2) | 02/28/2019 | M | 18,449 | (2) | (2) | Common Stock | 18,449 | $0.00 | 0 | D | ||||
Performance Stock Unit | (3) | 02/28/2019 | M | 5,518 | (3) | (3) | Common Stock | 5,518 | $0.00 | 0 | D |
Explanation of Responses: |
1. On February 28, 2019, pursuant to the terms of a Separation and Release Agreement (the "Separation Agreement"), a total of 11,825 unvested performance stock units granted to the Reporting Person on April 22, 2016 became vested and converted into shares of common stock, par value $0.01 per share ("Common Stock"), of Montage Resources Corporation (the "Company") on a one-for-one basis. |
2. On February 28, 2019, pursuant to the terms of the Separation Agreement, a total of 18,449 unvested performance stock units granted to the Reporting Person on February 24, 2017 became vested and converted into shares of Common Stock on a one-for-one basis. |
3. On February 28, 2019, pursuant to the terms of the Separation Agreement, a total of 5,518 unvested performance stock units granted to the Reporting Person on February 23, 2018 became vested and converted into shares of Common Stock on a one-for-one basis, while the remaining 6,715 unvested performance stock units were forfeited and canceled. |
4. Represents shares of Common Stock held by CKH Partners II, LP, which is controlled by the Reporting Person. |
Remarks: |
- All balances reflect a 15-to-1 reverse stock split of the Common Stock effected on February 28, 2019. - This beneficial ownership report is filed to report that the Reporting Person is no longer subject to Section 16 of the Securities Exchange Act of 1934, as amended, with respect to securities of the Company. |
/s/ Christopher Kent Hulburt | 03/04/2019 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |