0001515971-21-000003.txt : 20210111 0001515971-21-000003.hdr.sgml : 20210111 20210111161449 ACCESSION NUMBER: 0001515971-21-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210107 FILED AS OF DATE: 20210111 DATE AS OF CHANGE: 20210111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Roosa Robert M. CENTRAL INDEX KEY: 0001773076 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38870 FILM NUMBER: 21520952 MAIL ADDRESS: STREET 1: 5914 WEST COURTYARD DRIVE STREET 2: SUITE 100 CITY: AUSTIN STATE: TX ZIP: 78730 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Brigham Minerals, Inc. CENTRAL INDEX KEY: 0001745797 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 831106283 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 5914 W. COURTYARD DRIVE STREET 2: SUITE 200 CITY: AUSTIN STATE: TX ZIP: 78730 BUSINESS PHONE: (512) 220-6350 MAIL ADDRESS: STREET 1: 5914 W. COURTYARD DRIVE STREET 2: SUITE 200 CITY: AUSTIN STATE: TX ZIP: 78730 4 1 ownership.xml X0306 4 2021-01-07 0 0001745797 Brigham Minerals, Inc. MNRL 0001773076 Roosa Robert M. 5914 WEST COURTYARD DRIVE SUITE 200 AUSTIN TX 78730 1 1 0 0 Chief Executive Officer Class A Common Stock 2021-01-07 4 F 0 22722 10.99 D 225139 D Class A Common Stock 36111 I See Footnote Class B Common Stock 2020-07-20 5 G 0 E 5000 0 D 157537 I See Footnote Class B Common Stock 133102 I See Footnote Brigham Minerals Holdings LLC Units 0.00 2020-07-20 5 G 0 E 5000 0.00 D Class A Common Stock 5000 157537 I See Footnote Brigham Minerals Holdings, LLC Units 0.00 Class A Common Stock 133102 133102 I See Footnote Represents shares withheld by the Issuer to satisfy tax withholding obligations of the Reporting Person that arose in connection with the vesting and settlement of certain restricted stock units. Includes 132,354 restricted stock units awarded pursuant to the Brigham Minerals, Inc. 2019 Long Term Incentive Plan, which are subject to time based vesting upon continued employment through the applicable vesting dates. These securities are held by RSR Resources & Minerals Vested, LLC, of which the Reporting Person is the manager. These securities are held by RSR Resources & Minerals Unvested, LLC, of which the Reporting Person is the manager. Represents units of Brigham Minerals Holdings, LLC ("BMH LLC"), of which the Issuer is the managing member. Subject to the terms of the limited liability company agreement of BMH LLC, such units (together with a corresponding number of shares of Class B common stock) are exchangeable from time to time for shares of Class A common stock of the Issuer. See attached for Exhibit 24 - Power of Attorney /s/ Robert M. Roosa, by Kari A. Potts as Attorney-in-Fact 2021-01-11 EX-24 2 exhibit24.htm EXHIBIT 24 Exhibit 24

POWER OF ATTORNEY

January 11, 2021

Know all by these presents, that the undersigned hereby constitutes and appoints Blake C. Williams and Kari A. Potts of Brigham Minerals, Inc. (the “Company”) or any of them signing singly, and with full power of substitution, the undersigned’s true and lawful attorney-in-fact to:

1.                execute for and on behalf of the undersigned with respect to the Company, Schedules 13D and 13G and Forms 3, 4, and 5 in accordance with Sections 13 and 16(a) of the Securities Exchange Act of 1934 and the rules thereunder;

2.                do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Schedules 13D or 13G or Form 3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such form with the U.S. Securities and Exchange Commission and any stock exchange or similar authority; and

3.                take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-fact’s discretion.

The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact’s substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming any of the undersigned’s responsibilities to comply with Sections 13 and 16 of the Securities Exchange Act of 1934.

This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned’s holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

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IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of the date first written above.

/s/ Robert M. Roosa  
Name:  Robert M. Roosa  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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