SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 03/15/2021 |
3. Issuer Name and Ticker or Trading Symbol
EMPIRE PETROLEUM CORP [ EP ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) 03/24/2021 |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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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 | 8,558,185(1) | D | |
Common Stock | 1,698,000(1) | I | By Petroleum Independent & Exploration LLC |
Common Stock | 1,515,000(1) | I | By Big Red Revocable Trust |
Common Stock | 1,323,996(1)(2) | I | By Five Sterling LP |
Common Stock | 62,896(1)(3) | I | By spouse |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: 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 | ||||
Common Stock Warrant (Right to Buy) | 03/24/2021 | 12/31/2022 | Common Stock | 398,000(1) | 0.5(1) | I | By Petroleum Independent & Exploration LLC |
Common Stock Warrant (Right to Buy) | 03/24/2021 | 12/31/2022 | Common Stock | 30,000(1) | 0.5(1) | I | By Big Red Revocable Trust |
Common Stock Warrant (Right to Buy) | 03/24/2021 | 12/31/2022 | Common Stock | 60,000(1) | 0.5(1) | I | By Five Sterling LP |
Common Stock Warrant (Right to Buy) | 03/24/2021 | 12/31/2022 | Common Stock | 60,000(1) | 0.5(1) | I | By spouse |
Explanation of Responses: |
1. All share numbers and exercise prices are stated prior to giving effect to Empire's 1-for-4 reverse common stock split, which became effective on March 7, 2022. |
2. This amendment is being filed to report 8,996 shares of common stock that were erroneously omitted from the beneficial ownership of Five Sterling LP. |
3. This amendment is being filed to report 2,896 shares of common stock that were erroneously omitted from the beneficial ownership of Mr. Mulacek's spouse. |
Remarks: |
Mr. Mulacek is a director as of the date of this amendment, but was not a director as of the date of the filing of the original Form 3. |
/s/ Phil E. Mulacek | 04/24/2024 | |
** 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 5 (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. |