SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Hackedorn Lynne L.

(Last) (First) (Middle)
C/O TWO POST OAK CENTRAL
1980 POST OAK BOULEVARD, SUITE 1200

(Street)
HOUSTON TX 77056

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Cobalt International Energy, Inc. [ CIE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Vice President, Land
3. Date of Earliest Transaction (Month/Day/Year)
12/21/2009
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 12/21/2009 J(1) 167,248 A $0(1) 167,248 D
Common Stock 12/21/2009 A(1)(2) 179,825 A $0(1)(2) 347,073 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The reporting person received these shares of Common Stock as consideration for limited partnership interests in Cobalt International Energy, L.P. (the "Partnership") in connection with the reorganization of the Partnership, which involved the merger of the Partnership into a subsidiary of the Issuer, and the Issuer's initial public offering described in the prospectus dated December 15, 2009 (the "IPO").
2. 111,499 shares represent restricted shares granted under the Issuer's Long Term Incentive Plan (the "Plan") that will vest on April 1, 2010. 28,911 shares represent restricted shares granted under the Plan that will vest on December 21, 2014, subject to the terms of the award agreement under the Plan. 39,415 shares represent restricted shares granted under the Plan that will vest on December 21, 2014 but only if the average of the volume weighted average price of a share of the Issuer's Common Stock during the 90 day period ending on the day before December 21, 2014 equals or exceeds $13.50, subject to the terms of the award agreement under the Plan.
/s/ Jeffrey A. Starzec, as Attorney-in-Fact 12/21/2009
** 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 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).
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