0001437749-23-020447.txt : 20230721 0001437749-23-020447.hdr.sgml : 20230721 20230721162433 ACCESSION NUMBER: 0001437749-23-020447 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230719 FILED AS OF DATE: 20230721 DATE AS OF CHANGE: 20230721 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Forbes Keith E CENTRAL INDEX KEY: 0001831867 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39464 FILM NUMBER: 231102773 MAIL ADDRESS: STREET 1: 421 W. 3RD STREET STREET 2: SUITE 1000 CITY: FORT WORTH STATE: TX ZIP: 76102 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HighPeak Energy, Inc. CENTRAL INDEX KEY: 0001792849 STANDARD INDUSTRIAL CLASSIFICATION: DRILLING OIL & GAS WELLS [1381] IRS NUMBER: 843533602 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 421 W. 3RD STREET STREET 2: SUITE 1000 CITY: FORT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: (817) 850-9200 MAIL ADDRESS: STREET 1: 421 W. 3RD STREET STREET 2: SUITE 1000 CITY: FORT WORTH STATE: TX ZIP: 76102 4 1 rdgdoc.xml FORM 4 X0508 4 2023-07-19 0001792849 HighPeak Energy, Inc. HPK 0001831867 Forbes Keith E 421 W. 3RD STREET, SUITE 1000 FORT WORTH TX 76102 1 Vice President and Controller 0 Common Stock, par value $0.0001 per share 2023-07-19 4 P 0 14000 10.50 A 14000 I See Footnote 2 Common Stock, par value $0.0001 per share 250 I By Wife Employee Stock Option (right to buy) 10.50 2023-07-21 4 A 0 15000 0 A 2026-10-31 Common Stock, par value $0.0001 per share 15000 15000 D Represents shares of HighPeak Energy, Inc. (the "Issuer") common stock, par value $0.0001 per share ("Common Stock") purchased by the Reporting Person's personal investment vehicle from Roth Capital Partners, LLC (the "Underwriter") in an underwritten public offering conducted by the Issuer pursuant to an Underwriting Agreement between the Issuer and the Underwriter. The stock option was designed to comply with the requirements of Section 409A of the Internal Revenue Code of 1986, as amended, and the guidance thereunder, and is exercisable only during the 90 day period following the earlier to occur of the Reporting Person's separation from service due to death or disability, the occurrence of a change in control of the Issuer, or August 1, 2026. /s/ Steven W. Tholen as Attorney in Fact for Keith E. Forbes 2023-07-21