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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 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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Stepanek David F. C/O BRISTOW GROUP INC. 3151 BRIARPARK DRIVE, SUITE 700 HOUSTON, TX 77042 |
Executive Vice President, COO |
/s/ Justin D. Mogford, attorney-in-fact for David F. Stepanek | 03/11/2021 | |
**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) | Shares withheld to cover the associated tax liability upon the vesting of a portion of a previously granted restricted stock award, which grant was originally reported in Table I of the Reporting Person's Form 4 filed on March 12, 2020. |
(2) | These securities consist of (i) 15,094 restricted stock previously reported in Table I of the Reporting Person's Form 3A filed today, March 11, 2021 and 5,878 shares of common stock beneficially owned by the Reporting Person, both of which give effect to the 1:3 reverse stock split as reported in footnote 2 of the Reporting Person's Form 4 filed June 15, 2020, and (ii) the subtraction of the shares withheld as reported in Column 4 of this Form 4. |
(3) | Excludes 425 shares of common stock inadvertently included in the amount reported in Column 5 of the Form 4 filed by the Reporting Person on June 15, 2020 as a result of an error in connection with the calculation of the vesting of restricted stock and related withholding taxes. |