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