Statement of Changes in Beneficial Ownership (4)
2019年9月21日 - 7:51AM
Edgar (US Regulatory)
FORM 4
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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
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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
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SPARROW CURTIS J |
2. Issuer Name and Ticker or Trading Symbol
DEEP WELL OIL & GAS INC
[
DWOG
]
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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) CFO and Secretary
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(Last)
(First)
(Middle)
SUITE 700, 10150 - 100 STREET |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/19/2019
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(Street)
EDMONTON, A0 T5J 0P6
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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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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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Stock Option (Expired)
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$0.38
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9/19/2019
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J (1)
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600000 (1)
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(1)
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9/19/2019
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Common Stock
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600000 (1)
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$0.38
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1200000 (1)
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D
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Stock Option (Expired)
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$0.38
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9/19/2019
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J (2)
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1200000 (2)
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(2)
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9/19/2019
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Common Stock
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1200000 (2)
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$0.38
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0 (2)(3)
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I
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See footnote (4)
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Explanation of Responses:
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(1)
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On September 19, 2014, the Issuer's Board granted the Reporting Person, options to purchase 600,000 shares each of common stock at an exercise price of $0.38 per common share, with one-third vesting immediately, one-third vesting on September 19, 2015, and one-third vesting on September 19, 2016, each with a five-year life from the original grant date. The Reporting Person has not exercised any of these outstanding options. These options have now expired unexercised.
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(2)
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On September 19, 2014, the Issuer's Board granted Concorde Consulting, options to purchase 1,200,000 shares of common stock at an exercise price of $0.38 per common share, with one-half vesting immediately and one-half vesting on September 19, 2015, with a five-year life from the original grant date. Concorde Consulting has not exercised any of these outstanding options. These options have now expired unexercised.
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(3)
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As of September 19, 2019, the Reporting Person beneficially owns 1,978,571 shares (non-derivative securities) of the Issuer's common stock, of which (i) 600,000 shares are held directly; and (ii) 1,378,571 shares are held indirectly by Concorde Consulting.
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(4)
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Concorde Consulting is a company owned 100% by the Reporting Person, providing consulting services as Chief Financial Officer to the Issuer.
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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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SPARROW CURTIS J SUITE 700, 10150 - 100 STREET EDMONTON, A0 T5J 0P6
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X
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CFO and Secretary
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Signatures
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/s/ Curtis Sparrow
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9/20/2019
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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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Deep Well Oil and Gas (CE) (USOTC:DWOG)
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