Statement of Changes in Beneficial Ownership (4)
19 February 2021 - 9:16AM
Edgar (US Regulatory)
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 OF SECURITIES
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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
*
Borgen Dan |
2. Issuer Name and Ticker or Trading Symbol
USD Partners LP
[
USDP
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) SEE REMARKS |
(Last)
(First)
(Middle)
811 MAIN STREET, SUITE 2800 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
2/16/2021 |
(Street)
HOUSTON, TX 77002
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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COMMON UNITS (LIMITED PARTNER INTERESTS) | 2/16/2021 | | A | | 119526 (1) | A | $0 | 532407 (2) | D | |
COMMON UNITS (LIMITED PARTNER INTERESTS) | 2/16/2021 | | F | | 48542 (3) | D | $4.82 | 483865 (4) | D | |
COMMON UNITS (LIMITED PARTNER INTERESTS) | | | | | | | | 193419 | I | By KKB Holdings LLC |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 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 |
Explanation of Responses: |
(1) | Represents the grant of phantom units. Each phantom unit is the economic equivalent of one common unit of USDP. The phantom units vest in four annual installments commencing on the one-year anniversary of the issuance date. |
(2) | Includes 416,686 phantom units. |
(3) | Represents common units of limited partnership interest withheld by the Issuer to satisfy tax withholding obligations of the Reporting Person upon vesting of outstanding phantom units. |
(4) | Includes 304,194 phantom units. |
Remarks: The Reporting Person is President and Chief Executive Officer and a director of USD Partners GP LLC, the general partner of the Issuer (the "General Partner"). The Issuer is managed by the directors and executive officers of the General Partner. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Borgen Dan 811 MAIN STREET, SUITE 2800 HOUSTON, TX 77002 | X |
| SEE REMARKS |
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Signatures
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/s/ Adam K. Altsuler, Attorney-in-Fact for Daniel Kent Borgen | | 2/18/2021 |
**Signature of Reporting Person | Date |
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