0001655020-21-000234.txt : 20211101 0001655020-21-000234.hdr.sgml : 20211101 20211101172354 ACCESSION NUMBER: 0001655020-21-000234 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211101 FILED AS OF DATE: 20211101 DATE AS OF CHANGE: 20211101 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Brock Tom L CENTRAL INDEX KEY: 0001589561 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37907 FILM NUMBER: 211368378 MAIL ADDRESS: STREET 1: 1614 15TH STREET, SUITE 300 CITY: DENVER STATE: CO ZIP: 80202 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Extraction Oil & Gas, Inc. CENTRAL INDEX KEY: 0001655020 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 461473923 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 370 17TH STREET STREET 2: SUITE 5200 CITY: DENVER STATE: CO ZIP: 80202 BUSINESS PHONE: (720) 557-8300 MAIL ADDRESS: STREET 1: 370 17TH STREET STREET 2: SUITE 5200 CITY: DENVER STATE: CO ZIP: 80202 FORMER COMPANY: FORMER CONFORMED NAME: Extraction Oil & Gas, LLC DATE OF NAME CHANGE: 20151007 4 1 wf-form4_163580178559821.xml FORM 4 X0306 4 2021-11-01 1 0001655020 Extraction Oil & Gas, Inc. XOG 0001589561 Brock Tom L 370 17TH STREET SUITE 5200 DENVER CO 80202 0 1 0 0 VP, Chief Accounting Officer /s/ Tom L. Brock 2021-11-01