0001756043-24-000001.txt : 20240102 0001756043-24-000001.hdr.sgml : 20240102 20240102152703 ACCESSION NUMBER: 0001756043-24-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231231 FILED AS OF DATE: 20240102 DATE AS OF CHANGE: 20240102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Riley Kevin CENTRAL INDEX KEY: 0001756043 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15555 FILM NUMBER: 24502120 MAIL ADDRESS: STREET 1: 29 EAST RENO STREET 2: SUITE 500 CITY: OKLAHOMA CITY STATE: OK ZIP: 73104 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Riley Exploration Permian, Inc. CENTRAL INDEX KEY: 0001001614 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] ORGANIZATION NAME: 01 Energy & Transportation IRS NUMBER: 870267438 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 29 E. RENO AVENUE STREET 2: SUITE 500 CITY: OKLAHOMA CITY STATE: OK ZIP: 73104 BUSINESS PHONE: 405-415-8699 MAIL ADDRESS: STREET 1: 29 E. RENO AVENUE STREET 2: SUITE 500 CITY: OKLAHOMA CITY STATE: OK ZIP: 73104 FORMER COMPANY: FORMER CONFORMED NAME: TENGASCO INC DATE OF NAME CHANGE: 19960612 4 1 wk-form4_1704227213.xml FORM 4 X0508 4 2023-12-31 1 0001001614 Riley Exploration Permian, Inc. REPX 0001756043 Riley Kevin C/O RILEY EXPLORATION PERMIAN, INC. 29 EAST RENO, SUITE 500 OKLAHOMA CITY OK 73104 0 1 0 0 PRESIDENT 0 Common Stock, par value $0.001 per share 2023-12-31 4 D 0 20000 0 D 202726 D These shares were forfeited to the Issuer pursuant to that certain Separation and Release Agreement by and between the Filer and the Issuer dated December 21, 2023 and effective as of December 28, 2023. This amount includes 64,887 shares of restricted common stock subject to vesting and certain other restrictions. /s/ Kevin Riley 2024-01-02