FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 12/30/2022 |
3. Issuer Name and Ticker or Trading Symbol
ALPINE SUMMIT ENERGY PARTNERS, INC. [ ALPS ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Class A Subordinate Voting Shares | 1,066,236 | D | |
Class A Subordinate Voting Shares | 14,000 | I | Held by spouse |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Deferred Share Units | (1) | (1) | Class A Subordinate Voting Shares | 60,865 | (1) | D | |
Class B Non-Voting Units | (2) | (2) | Class A Subordinate Voting Shares | 21,656 | $0(2) | D |
Explanation of Responses: |
1. 36,517 deferred share units (DSUs) vest on June 1, 2022; 24,348 DSUs vest on June 1, 2023. The underlying Class A subordinate voting shares will not be issued to the reporting person, and the reporting personal shall not have any voting or dispositive rights with respect to the underlying Class A subordinate voting shares, until termination of the reporting person's employment or services as a director of the Issuer. |
2. Represents Class B non-voting units of HB2 Origination, LLC, which are exchangeable at the option of the reporting person for Class A subordinate voting shares of the Issuer on a one-for-one basis. |
Remarks: |
Exhibit 24.1 Power of Attorney |
/s/ Reagan Brown as attorney-in-fact for Stephen Schaefer | 12/30/2022 | |
** 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 5 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |