0001655020-18-000113.txt : 20181019
0001655020-18-000113.hdr.sgml : 20181019
20181019161644
ACCESSION NUMBER: 0001655020-18-000113
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181017
FILED AS OF DATE: 20181019
DATE AS OF CHANGE: 20181019
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kelley Russell T JR
CENTRAL INDEX KEY: 0001685847
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37907
FILM NUMBER: 181130611
MAIL ADDRESS:
STREET 1: 370 17TH STREET
STREET 2: SUITE 5300
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 5300
CITY: DENVER
STATE: CO
ZIP: 80202
BUSINESS PHONE: (720) 557-8300
MAIL ADDRESS:
STREET 1: 370 17TH STREET
STREET 2: SUITE 5300
CITY: DENVER
STATE: CO
ZIP: 80202
FORMER COMPANY:
FORMER CONFORMED NAME: Extraction Oil & Gas, LLC
DATE OF NAME CHANGE: 20151007
4
1
wf-form4_153998018107873.xml
FORM 4
X0306
4
2018-10-17
0
0001655020
Extraction Oil & Gas, Inc.
XOG
0001685847
Kelley Russell T JR
370 17TH STREET
SUITE 5300
DENVER
CO
80202
0
1
0
0
Chief Financial Officer
COMMON STOCK
2018-10-17
4
F
0
43382
10.81
D
1564395
D
COMMON STOCK
1231995
I
See Footnote (1)
These shares are owned by Extraction Employee Incentive, LLC, an entity in which the reporting person owns a membership interest. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any. Pursuant to Rule 16a-1(a)(4) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), this filing shall not be deemed an admission that the Reporting Person is, for purposes of Section 16 of the Exchange Act or otherwise, the beneficial owners of any equity securities in excess of their respective pecuniary interests.
/s/ Eric J. Christ, Attorney-in-Fact
2018-10-19