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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 | ||||||||
Company Stock Option | $ 2.28 | 10/27/2010 | D | 16,832 | (4) | 05/15/2018 | Common Stock | 16,832 | (4) | 0 | D | ||||
Company Stock Option | $ 2.08 | 10/27/2010 | D | 22,500 | (5) | 08/03/2019 | Common Stock | 22,500 | (5) | 0 | D | ||||
Company Stock Option | $ 1.26 | 10/27/2010 | D | 100,000 | (6) | 01/01/2020 | Common Stock | 100,000 | (6) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Shaw Lawrence J PO BOX 3761 LAFAYETTE, LA 70502 |
VP of Sales - Land & Offshore |
Lawrence Shaw | 11/05/2010 | |
**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) | Disposed of pursuant to the Agreement and Plan of Merger, dated as of June 3, 2010 by and among Wellspring OMNI Holdings Corporation, Wellspring OMNI Acquisition Corporation and OMNI Energy Services Corp. (the "Merger") in exchange for $2.75 per share (the "Merger Consideration"). |
(2) | Includes 9,375 shares representing former shares of restricted stock that vested immediately prior to the effective time of the Merger and converted into the right to receive the Merger Consideration. |
(3) | Includes 13,418 shares representing former shares of restricted stock that vested prior to the effective time of the Merger and converted into the right to receive the Merger Consideration and 22,360 shares representing former shares of restricted stock that were cancelled at closing. |
(4) | In accordance with the terms of the Merger, this option was cancelled in exchange for a cash payment of $7,911.04. |
(5) | In accordance with the terms of the Merger, this option was cancelled in exchange for a cash payment of $15,075.00. |
(6) | In accordance with the terms of the Merger, this option was cancelled in exchange for a cash payment of $149,000.00. |