Sec Form 4 Filing - Owens Matthew R @ Extraction Oil & Gas, Inc. - 2016-11-14

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Owens Matthew R
2. Issuer Name and Ticker or Trading Symbol
Extraction Oil & Gas, Inc. [ XOG]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
President
(Last) (First) (Middle)
370 17TH STREET, SUITE 5300
3. Date of Earliest Transaction (MM/DD/YY)
11/14/2016
(Street)
DENVER, CO80202
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 11/14/2016 J( 1 ) 978,469 ( 1 ) D $ 0 1,466,430 D
Common Stock 11/14/2016 J( 1 ) 2,717,970 ( 1 ) A $ 0 2,717,970 I ( 2 ) See Footnote (2)
Common Stock 1,944,898 I ( 3 ) See Footnote (3)
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Owens Matthew R
370 17TH STREET
SUITE 5300
DENVER, CO80202
X President
Signatures
/s/ Tom Brock, Attorney-in-Fact 11/16/2016
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Represents shares of common stock that the reporting person transferred to Extraction Employee Incentive, LLC ("EEI") for the purpose of making grants of restricted stock units (the "Awards") to certain employees (the "Recipients") of Extraction Oil & Gas, Inc. and its subsidiaries. Upon satisfaction of the vesting conditions with respect to such Awards, the Recipients will receive shares of common stock held by EEI in settlement of such Awards. The shares acquired by EEI include shares transferred by other persons, and is reported in the aggregate.
( 2 )These shares are owned by Extraction Employee Incentive, LLC, an entity in which the reporting person owns a membership interest. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any. Pursuant to Rule 16a-1(a)(4) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), this filing shall not be deemed an admission that the Reporting Person is, for purposes of Section 16 of the Exchange Act or otherwise, the beneficial owners of any equity securities in excess of their respective pecuniary interests.
( 3 )These shares are owned by OFI Properties, LLC, of which Mr. Owens holds 100% of the managing interest. The Matthew R. Owens 2016 Grantor Retained Annuity Trust, of which Mr. Owens is Trustee, owns a 75% non-managing interest in OFI Properties, LLC.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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