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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Class A Units representing limited partner interests | (1) | 01/01/2015 | C | 3,750,000 | (5) | (5) | Common Units representing limited partner interests | 3,750,000 | $ 0 | 0 | I | See footnote (2) | |||
Subordinated Units representing limited partner interests | (4) | 02/17/2015 | C | 8,389,709 | (6) | (6) | Common Units representing limited partner interests | 8,389,709 | $ 0 | 0 | I | See footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SemGroup Corp TWO WARREN PLACE 6120 SOUTH YALE AVENUE, SUITE 700 TULSA, OK 74136-4216 |
X | X | ||
Rose Rock Midstream Holdings, LLC TWO WARREN PLACE 6120 S. YALE AVENUE, SUITE 700 TULSA, OK 74136-4216 |
X | X | ||
Rose Rock Midstream Corp TWO WARREN PLACE 6120 S. YALE AVENUE, SUITE 700 TULSA, OK 74136-4216 |
X |
Candice L. Cheeseman, Secretary and General Counsel of SemGroup Corporation | 02/18/2015 | |
**Signature of Reporting Person | Date | |
Candice L. Cheeseman, Secretary and General Counsel of Rose Rock Midstream Holdings, LLC | 02/18/2015 | |
**Signature of Reporting Person | Date | |
Candice L. Cheeseman, Secretary and General Counsel of Rose Rock Midstream Corporation | 02/18/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | 3,750,000 Class A Units converted into Common Units on a one-for-one basis on January 1, 2015. |
(2) | This Form 4 is being filed jointly by SemGroup Corporation ('SemGroup'), Rose Rock Midstream Holdings, LLC ('Holdings') and Rose Rock Midstream Corporation ('RRMC). SemGroup directly owns 100% of the outstanding members interests of Holdings. Holdings directly owns 100% of the issued and outstanding shares of common stock of RRMC. SemGroup may therefore be deemed to beneficially own securities of the Issuer owned directly by Holdings and RRMS and Holdings may therefore be deemed to beneficially own securities of the Issuer owned directly by RRMC. |
(3) | In connection with the closing of the transactions contemplated by that certain Amended and Restated Contribution Agreement dated as of February 13, 2015, by and among SemGroup, SemDevelopment, L.L.C., Holdings, Rose Rock Midstream GP, LLC, the Issuer and Rose Rock Midstream Operating, LLC, the Issuer issued to Holdings, among other consideration, 1,750,000 Common Units representing limited partner interests in the Issuer in exchange for 100% membership interest in each of Wattenberg Holding, LLC and Glass Mountain Holding, LLC. Glass Mountain Holding, LLC owns a 50% membership interest in Glass Mountain Pipeline, LLC. |
(4) | 8,389,709 Subordinated Units converted into Common Units on a one-for-one basis on February 17, 2015. |
(5) | The Class A Units have no expirations date and convert into Common Units representing limited partner interests in the Issuer on a one-for-one basis on the first day of the month immediately following the first month for which average daily throughput volumes on the White Cliffs Pipeline for such month are 125 thousand barrels per day or greater. |
(6) | The Subordinated Units have no expiration date and convert into Common Units on a one-for-one basis at the end of the subordination period described in the Issuers Registration Statement on Form S-1 (File No. 333-176260). |