0001104659-21-122737.txt : 20211005 0001104659-21-122737.hdr.sgml : 20211005 20211005061219 ACCESSION NUMBER: 0001104659-21-122737 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211001 FILED AS OF DATE: 20211005 DATE AS OF CHANGE: 20211005 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Royal Ronald CENTRAL INDEX KEY: 0001642113 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34018 FILM NUMBER: 211305107 MAIL ADDRESS: STREET 1: C/O GRAN TIERRA ENERGY INC. STREET 2: 200, 150 13 AVENUE SW CITY: CALGARY STATE: A0 ZIP: T2R 0V2 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: GRAN TIERRA ENERGY INC. CENTRAL INDEX KEY: 0001273441 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 900, 520 3RD AVENUE S.W. CITY: CALGARY STATE: A0 ZIP: T2P 0R3 BUSINESS PHONE: (403) 265-3221 MAIL ADDRESS: STREET 1: 900, 520 3RD AVENUE S.W. CITY: CALGARY STATE: A0 ZIP: T2P 0R3 FORMER COMPANY: FORMER CONFORMED NAME: GRAN TIERRA ENERGY, INC. DATE OF NAME CHANGE: 20051130 FORMER COMPANY: FORMER CONFORMED NAME: GOLDSTRIKE INC DATE OF NAME CHANGE: 20040113 FORMER COMPANY: FORMER CONFORMED NAME: GOLKSTRIKE INC DATE OF NAME CHANGE: 20031216 4 1 tm2129246-5_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-10-01 0 0001273441 GRAN TIERRA ENERGY INC. GTE 0001642113 Royal Ronald C/O GRAN TIERRA ENERGY INC. 900, 520 3 AVENUE SW CALGARY A0 T2P 0R3 ALBERTA, CANADA 1 0 0 0 Deferred Stock Units 2021-10-01 4 A 0 55436 0 A Common Stock 55436 965286 D Stock Option (Right to Buy) 0.76 2021-10-01 4 A 0 13824 0 A 2021-10-01 2026-10-01 Common Stock 13824 13824 D Deferred stock units convert into common stock on a one-for-one basis. Each deferred stock unit represents a contingent right to receive one share of Gran Tierra Energy Inc. common stock. The deferred stock units vest in full at such time as the reporting person ceases to be a member of the Board of Directors of the Issuer. /s/ Diane Phillips, Attorney-In Fact 2021-10-05