0001515971-22-000003.txt : 20220110 0001515971-22-000003.hdr.sgml : 20220110 20220110161551 ACCESSION NUMBER: 0001515971-22-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220110 FILED AS OF DATE: 20220110 DATE AS OF CHANGE: 20220110 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: 22521420 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 2022-01-10 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 2022-01-10 4 F 0 57426 21.09 D 307378 D Class A Common Stock 36111 I See Footnote Class B Common Stock 2021-03-19 5 G 0 E 5000 0.00 D 152537 I See Footnote Class B Common Stock 133102 I See Footnote Brigham Minerals Holdings, LLC Units 0.00 2021-03-19 5 G 0 E 5000 0.00 D Class A Common Stock 5000 152537 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 137,124 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. /s/ Robert M. Roosa, by Kari A. Potts as Attorney-in-Fact 2022-01-10