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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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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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*
103 NORTHPARK BOULEVARD, SUITE 300 |
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(Street)
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2. Issuer Name and Ticker or Trading Symbol
HORNBECK OFFSHORE SERVICES INC /LA
[ HOS ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Vice President & CIO |
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3. Date of Earliest Transaction
(Month/Day/Year) 02/05/2015
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction 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 |
V |
Amount |
(A) or (D) |
Price |
COMMON STOCK |
05/15/2014 |
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G |
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1,200 |
D |
$0.00
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116,164 |
D |
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COMMON STOCK |
02/05/2015 |
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F |
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1,875
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D |
$22.94
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114,814
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D |
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COMMON STOCK |
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50 |
I |
By UGMA custodian for children |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of Responses: |
Remarks: |
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/s/ Beth A. LaBrosse as POA for John S. Cook |
02/09/2015 |
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** 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). |
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. |
SPECIAL POWER OF ATTORNEY
The undersigned, John S. Cook, of 103 Northpark Blvd., Suite 300,
Covington, LA
70433, does hereby appoint, reserving full power of substitution and revocation:
Todd M.
Hornbeck, James O. Harp, Jr., Mark S. Myrtue, Beth A. LaBrosse and Michele M.
Giammolva,
each a resident of Louisiana, to act jointly or severally at their discretion,
one with full authority
to act for the others, as his true and lawful attorney-in-fact, upon the
following terms and
conditions:
1. Special Powers. The attorney-in-fact may act in the name, place and
stead of the
undersigned, and on behalf of the undersigned do and execute all or any of the
following acts,
deeds, and things, to-wit:
(a) Execute for and on behalf of the undersigned, in the
undersigned's
capacity as an executive officer, director and/or 10% or more beneficial owner
of shares of
common stock of Hornbeck Offshore Services, Inc. (the "Company"), Forms 3, 4,
and 5, as
applicable, in accordance with Section 16 of the Securities Exchange Act of
1934, as amended
(the "Exchange Act"), and the rules thereunder, and a Form ID and any other
documents
necessary or appropriate to obtain codes or passwords to enable the undersigned
reporting person
to make electronic filings with the SEC.
(b) Do and perform any and all acts for and on behalf of the
undersigned
which may be necessary or desirable to complete and execute any such Form 3, 4,
or 5, complete
and execute any amendment or amendments thereto, and file such form and any
amendments
with the United States Securities and Exchange Commission and any stock
exchange, association
or similar authority.
(c) Take any other action of any type whatsoever in connection with
the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest
of, or legally required by, the undersigned, it being understood that the
documents executed by
such attorney-in-fact on behalf of the undersigned pursuant to this Special
Power of Attorney
shall be in such form and shall contain such terms and conditions as such
attorney-in-fact may
approve in such attorney-in-fact's discretion.
(d) The undersigned hereby grants to such attorney-in-fact full
power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or
proper to be done in the exercise of any of the rights and powers herein
granted, as fully to all
intents and purposes as the undersigned might or could do if personally present,
hereby ratifying
and confirming all that such attorney-in-fact shall lawfully do or cause to be
done by virtue of
this power of attorney and the rights and powers herein granted. The
undersigned acknowledges
that the foregoing attorney-in-fact, in serving in such capacity at the request
of the undersigned,
is not assuming, nor is the Company assuming, any of the undersigned's
responsibilities to
comply with Section 16 of the Exchange Act, or any other provision of the
federal or state
securities laws, rules and regulations.
2. Effective Period. This Special Power of Attorney, and the powers
expressed
herein, shall be effective from June 19, 2014, and shall remain in full force
and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's
holdings of and transactions in securities issued by the Company, unless earlier
(a) revoked by
the undersigned in accordance with the provisions contained herein or (b)
superseded by a new
special power of attorney regarding the purposes outlined in the first paragraph
hereof dated as
of a later date.
3. Construction. This instrument is a special power of attorney, granting
to the
attorney-in-fact only the specific powers expressed herein.
4. Revocation. This Special Power of Attorney may be revoked as follows:
(a) Should the employment of either Todd M. Hornbeck, James O. Harp,
Jr.,
Mark S. Myrtue, Beth A. LaBrosse or Michele M. Giammolva by Hornbeck Offshore
Operators,
LLC be terminated, for whatever reason, this Special Power of Attorney shall be
deemed
revoked as to that individual, effective immediately on the date of termination
of such
employment.
(b) A written revocation executed by the undersigned and delivered
to the
Company at its principal place of business shall constitute a voluntary
revocation of this Special
Power of Attorney.
(c) The undersigned agrees that any third party who receives a copy
of this
power of attorney may act under it. Revocation of this power of attorney is not
effective as to a
third party until the third party receives actual notice of the revocation. The
undersigned agrees
to indemnify the third party for any claims that arise against the third party
because of reliance
on this power of attorney.
5. Disability of Principal. This Special Power of Attorney shall not
terminate upon
the undersigned's disability or incompetency.
6. Bond. The attorney-in-fact shall not be obligated to furnish bond or
other
security.
7. Reliance. This Special Power of Attorney shall be conclusive proof
that the
rights, power, and authority granted to the attorney-in-fact are in full force
and effect and may be
relied upon by any person who acts in good faith under this power of attorney.
The undersigned's
death shall not revoke or terminate this agency as to the attorney-in-fact or
any other person who
without actual knowledge of the undersigned's death acts in good faith under
this power of
attorney. An affidavit executed by the attorney-in-fact, stating that he did
not have at the time of
doing an act pursuant to this power of attorney actual knowledge of the
revocation or termination
of this power of attorney, is in the absence of fraud, conclusive proof of the
validity of the
attorney-in-fact's act.
8. Incapacity of Attorney-in-Fact. In the event any attorney-in-fact
serving becomes
unable to discharge his fiduciary duties hereunder by reason of accident,
physical or mental
deterioration, or other similar cause as certified by two independent, licensed
physicians, each
affirming that he has examined the attorney-in-fact and that he has concluded
based on his
examination that the attorney-in-fact is unable to discharge his duties
hereunder, that attorney-in-
fact shall thereupon cease to be the attorney-in-fact as if he had resigned on
the date of that
certification.
9. Governing Law. This power of attorney shall be governed by the laws of
the
State of Louisiana in all respects. Should any provision hereof be held
invalid, that invalidity
shall not affect the other provisions which shall remain in full force and
effect.
10. Copies. This instrument may be filed of record in any jurisdiction as
may be
deemed appropriate by the attorney-in-fact, and copies of this instrument
certified as "true"
copies by the Clerk of any county or parish in which this instrument is filed
shall be treated as
original copies for all purposes.
11. Captions. The captions used in this instrument have been inserted for
administrative convenience only and do not constitute matters to be construed in
interpreting this
power of attorney.
12. Prior Special Powers of Attorney. This Special Power of Attorney
supersedes any
power of attorney previously executed by the undersigned regarding the purposes
outlined in the
first paragraph hereof ("Prior Special Powers of Attorney"), and the authority
of the attorneys-in-
fact named in any Special Prior Powers of Attorney is hereby revoked.
SIGNED the 19th day of June, 2014.
/s/ John S. Cook
JOHN S. COOK
STATE OF LOUISIANA
PARISH OF ST. TAMMANY
BEFORE ME, the undersigned, a Notary Public in and for said State, on this
day
personally appeared John S. Cook, known to me to be at least eighteen (18) years
of age and the
person whose name is subscribed to the foregoing instrument, and acknowledged to
me that he
executed the same for the purposes and consideration therein expressed.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this 19th day of June, 2014.
/s/ Michael J. Nicaud
Attorney at Law and Notary Public
Michael J. Nicaud
Notary Number: 83398
My commission expires at death.
[SEAL]