Amended Statement of Changes in Beneficial Ownership (4/a)
March 06 2017 - 5:02PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
JAGGERS JOSEPH N
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2. Issuer Name
and
Ticker or Trading Symbol
Jagged Peak Energy Inc.
[
JAG
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
See Remarks
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(Last)
(First)
(Middle)
1125 17TH STREET, SUITE 2400
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3. Date of Earliest Transaction
(MM/DD/YYYY)
2/1/2017
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(Street)
DENVER, CO 80202
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
2/3/2017
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common stock
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2/1/2017
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A
(1)
(3)
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4987423
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A
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$0.00
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4987423
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D
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Common stock
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2/1/2017
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A
(2)
(3)
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1662474
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A
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$0.00
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1662474
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I
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By Jaggers Investments, LLLP
(4)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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Pursuant to the transactions described in footnotes (1) and (2) to the reporting person's original Form 4 filed on February 3, 2017, Mr. Jaggers received 4,987,423 shares of common stock. The reporting person's original Form 4 filed on February 3, 2017 misstated the number of shares of common stock received by Mr. Jaggers.
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(
2)
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Pursuant to the transactions described in footnotes (1) and (2) to the reporting person's original Form 4 filed on February 3, 2017, Jaggers Investments, LLLP received 1,662,474 shares of common stock. The reporting person's original Form 4 filed on February 3, 2017 misstated the number of shares of common stock received by Jaggers Investments, LLLP.
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(
3)
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This Form 4 is not reporting any additional transactions by the reporting person. The aggregate number of shares of common stock beneficially owned by the reporting person was correctly stated in the original Form 4 filed on February 3, 2017; however, the split between the number of shares of common stock owned by Mr. Jaggers and Jaggers Investments, LLLP was misstated.
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(
4)
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Mr. Jaggers has sole voting and dispositive power over these shares. Jaggers Investments, LLLP is an entity, of which Mr. Jaggers is general partner, owned by Mr. Jaggers and certain members of his family.
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Remarks:
Chairman, Chief Executive Officer and President.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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JAGGERS JOSEPH N
1125 17TH STREET, SUITE 2400
DENVER, CO 80202
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X
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See Remarks
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Signatures
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/s/ Joseph N. Jaggers, by Christopher I. Humber, as Attorney-in-Fact
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3/6/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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