SEC FORM 4 SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Giberga Samuel A

(Last) (First) (Middle)
103 NORTHPARK BOULEVARD, SUITE 300

(Street)
COVINGTON LA 70433

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
HORNBECK OFFSHORE SERVICES INC /LA [ HOS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Executive VP & General Counsel
3. Date of Earliest Transaction (Month/Day/Year)
03/08/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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
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 (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 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 (Month/Day/Year) 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: 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
PHANTOM STOCK(1) (1) 03/08/2019 A 276,136 (1) 03/08/2022 COMMON STOCK 276,136 $0.00 276,136 D
STOCK APPRECIATION RIGHTS(2) $1.38 03/08/2019 A 184,091 (2) 03/08/2029 COMMON STOCK 184,091 $0.00 184,091 D
Explanation of Responses:
1. The phantom stock units vest in three equal annual installments on each of the 1st, 2nd and 3rd anniversaries of the grant date. Each phantom stock unit represents the right to receive, upon settlement, the economic equivalent of one share of the Company's common stock. Phantom stock units may be settled in shares of Company common stock, cash, or a combination thereof (at the election of the issuer).
2. The stock appreciation rights vest and become exercisable in three equal annual installments on each of the 1st, 2nd and 3rd anniversaries of the grant date. The stock appreciation rights represent the right to receive, upon exercise, a number of shares of Company common stock, cash, or a combination thereof (at the election of the issuer) equal to the product of the aggregate number of shares of Company common stock with respect to which the stock appreciation right award is exercised and the excess of the fair market value of a share of Company common stock as of the date of exercise over the base price specified above.
Remarks:
/s/ Beth A. LaBrosse, as POA for Samuel A. Giberga 03/12/2019
** 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 4 (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).
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