0001140361-13-000592.txt : 20130103 0001140361-13-000592.hdr.sgml : 20130103 20130103152252 ACCESSION NUMBER: 0001140361-13-000592 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121231 FILED AS OF DATE: 20130103 DATE AS OF CHANGE: 20130103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BAILEY JEFFREY R CENTRAL INDEX KEY: 0001251651 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15555 FILM NUMBER: 13506243 MAIL ADDRESS: STREET 1: 603 MAIN AVENUE STE. 500 CITY: KNOXVILLE STATE: TN ZIP: 37902 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TENGASCO INC CENTRAL INDEX KEY: 0001001614 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 870267438 STATE OF INCORPORATION: TN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 11121 KINGSTON PIKE STREET 2: SUITE E CITY: KNOXVILLE STATE: TN ZIP: 37934 BUSINESS PHONE: 865-675-1554 MAIL ADDRESS: STREET 1: 11121 KINGSTON PIKE STREET 2: SUITE E CITY: KNOXVILLE STATE: TN ZIP: 37934 4 1 doc1.xml FORM 4 X0306 4 2012-12-31 0 0001001614 TENGASCO INC TGC 0001251651 BAILEY JEFFREY R 11121 KINGSTON PIKE SUITE E KNOXVILLE TN 37934 1 1 0 0 CEO Common Stock 2012-12-31 4 S 0 500000 1.06 D 249494 D Option Right to buy .44 2010-08-30 4 J 0 1 0 A 2011-08-30 2015-08-29 Common Stock 127000 1 D Shares were sold in a private transaction to SSB Ventures LLC, a Delaware limited liability company in which Jeffrey R. Bailey is a member, for the consideration of a promissory note dated December 31, 2012 by SSB Ventures LLC in amount of $530,000. Pursuant to the SSB Ventures LLC company agreement, Jeffrey R. Bailey retains the power to direct the voting by SSB Ventures LLC of the shares sold to it by Jeffrey R. Bailey. Grant of option pursuant to the Tengasco, Inc. Stock Incentive Plan. s/Jeffrey R. Bailey 2013-01-03