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) 07/01/2011 |
3. Issuer Name and Ticker or Trading Symbol
Samson Oil & Gas LTD [ SSN ] |
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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) |
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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) |
American Depositary Shares | 70,713 | D |
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 | ||||
Options to purchase Ordinary Shares | 01/19/2011(1) | 12/31/2014 | Ordinary Shares | 6,500,000 | $0.09(2) | D | |
2011 Performance Bonus | (3) | (3) | Ordinary Shares | (4) | (4) | D |
Explanation of Responses: |
1. The vesting schedule is: 33% on 1/31/2011; 33% on 1/31/2012; and 34% on 1/31/2013. Of the options that vested on 1/31/2011, the reporting person exercised 500,000 options. |
2. The options are priced in Australian dollars. This is the US dollar equivalent of the exercise price of A$0.08 using rate of exchange published by the Reserve Bank of Australia for June 30, 2011 (US$1.00=A$0.9311). |
3. In the event any performance rights vest, the performance rights will be settled in cash between January 1, 2012 and March 15, 2012. |
4. The reporting person has a contractual right to receive a 2011 Performance Bonus of up to $224,000 based on a formula that is derived from the difference between the combined volume weighted average price for the issuer's ordinary shares and American Depositary Shares in December 2011 compared to the corresponding prices in December 2010. |
/s/ Daniel Gralla | 07/01/2011 | |
** 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. |