0001655020-19-000011.txt : 20190118 0001655020-19-000011.hdr.sgml : 20190118 20190118174258 ACCESSION NUMBER: 0001655020-19-000011 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190117 FILED AS OF DATE: 20190118 DATE AS OF CHANGE: 20190118 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: 19533935 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_154785136214907.xml FORM 4 X0306 4 2019-01-17 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 2019-01-17 4 J 0 476000 4.78 D 755995 I See Footnote (2) COMMON STOCK 1546395 D As previously disclosed, this represents the vesting of restricted stock units previously awarded to certain employees and the subsequent distribution of common stock to such employees in connection therewith. 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 2019-01-18