0001434842-16-000049.txt : 20160105 0001434842-16-000049.hdr.sgml : 20160105 20160105113826 ACCESSION NUMBER: 0001434842-16-000049 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160101 FILED AS OF DATE: 20160105 DATE AS OF CHANGE: 20160105 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Forbes Energy Services Ltd. CENTRAL INDEX KEY: 0001434842 STANDARD INDUSTRIAL CLASSIFICATION: OIL, GAS FIELD SERVICES, NBC [1389] IRS NUMBER: 000000000 STATE OF INCORPORATION: D0 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3000 SOUTH BUSINESS HIGHWAY 281 CITY: ALICE STATE: TX ZIP: 78332 BUSINESS PHONE: 361-664-0549 MAIL ADDRESS: STREET 1: 3000 SOUTH BUSINESS HIGHWAY 281 CITY: ALICE STATE: TX ZIP: 78332 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Burris Travis H. CENTRAL INDEX KEY: 0001513563 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35281 FILM NUMBER: 161320701 MAIL ADDRESS: STREET 1: 3000 SOUTH BUSINESS HIGHWAY 281 CITY: ALICE STATE: TX ZIP: 78332 4 1 wf-form4_145201189217672.xml FORM 4 X0306 4 2016-01-01 0 0001434842 Forbes Energy Services Ltd. FES 0001513563 Burris Travis H. 3000 SOUTH BUSINESS HIGHWAY 281 ALICE TX 78332 1 0 0 0 Common Stock 2016-01-01 4 M 0 10584 0 A 110950 D Common Stock 2016-01-01 4 D 0 10584 0.29 D 100366 D Common Stock 450 I By son Restricted Stock Units 2016-01-01 4 M 0 10584 0 D Common Stock 10584.0 10584 D On January 1, 2016, the reporting person had an award of restricted stock units that vested in accordance with the provisions in a grant made on June 15, 2015. Each restricted stock unit converts into common stock on a one-for-one basis. The restricted stock units were settled in cash valued at $0.29 per share, based on the market closing price on December 31, 2015. No shares were actually, issued, converted, or sold in connection with this transaction. The Reporting Person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for the purposes of Section 16 or for any other purpose. On June 15, 2015, the reporting person was granted 42,336 resticted stock units, vesting quarterly in four equal installments beginning on July 1, 2015 This amount reflects a correction made to the total amount of derivate securities beneficially owned by the reporting person in the reporting person's Form 4 filed on October 5, 2015. The total amount of derivate securities beneficially owned by the reporting person disclosed in the Form 4 filed on October 5, 2015 was inadvertently incorrect because a transposition error. The number of derivative securities disposed of in the reporting person's Form 4 filed on October 5, 2015 should have been 10,584 and not 10,854. /s/ L. Melvin Cooper, Power of Attorney for Travis H. Burris 2016-01-05