FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/01/2010 |
3. Issuer Name and Ticker or Trading Symbol
CAMAC Energy Inc. [ CAK ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 250,000(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option (Right to Buy) | (2) | 10/01/2015 | Common Stock | 1,500,000 | $3.43 | D |
Explanation of Responses: |
1. Common Stock of Issuer granted to Reporting Person pursuant to Issuer's 2009 Equity Incentive Plan and subject thereto. Grant of restricted stock subject to forfeiture. 100% of the shares will become vested and nonforfeitable on the twelve (12) month anniversary of October 1, 2010 (the "Vesting Commencement Date"), for so long as the recipient of the stock remains an employee of or consultant to the Company and subject to the terms and conditions of the Restricted Stock Purchase Agreement entered into by and between the Company and the Grantee. |
2. Options to purchase Common Stock of Issuer pursuant to Issuer's 2009 Equity Incentive Plan and subject thereto. Vesting at the rate of 1/3 of the total number of Option Shares (500,000 shares) on each of December 1, 2011, December 1, 2012, and December 1, 2013, for so long as the recipient of the Option remains an employee of or consultant to the Company, and subject to the terms and conditions of the Stock Option Agreement to be entered into by and between the Company and the Optionee. |
Remarks: |
/s/ Clark Moore, Attorney in Fact | 10/08/2010 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |