- Annual Statement of Changes in Beneficial Ownership (5)
February 27 2012 - 5:05PM
Edgar (US Regulatory)
FORM 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).
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Form 3 Holdings Reported
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X
]
Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0362
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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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
REYNOLDS DOUGLAS V
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2. Issuer Name
and
Ticker or Trading Symbol
Energy Services of America CORP [ESA]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
100 INDUSTRIAL LANE
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
9/30/2011
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(Street)
HUNTINGTON, WV 25702
(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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Amount
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(A) or (D)
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Price
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Common Stock
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8/15/2008
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J4
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442891
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A
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(1)
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1207891
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D
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Common Stock
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12/28/2010
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S4
(2)
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21150
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D
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$
4.6
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1166741
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D
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Common Stock
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12/31/2010
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S4
(3)
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511
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D
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$
4.6
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1153230
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D
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Common Stock
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9/28/2011
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A4
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9049
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A
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(4)
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1162279
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D
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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 Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. 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
(MM/DD/YYYY)
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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 at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Warrants
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$
5
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9/28/2011
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D4
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76924
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8/29/2011
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10/12/2011
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Common Stock
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76924
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(4)
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0
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D
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Explanation of Responses:
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(
1)
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On August 15, 2008, Energy Services Acquisition Corp. (ESA) acquired C.J. Hughes Construction Company, Inc. (CJ) by issuing 6,434.7 shares of ESA for each share of CJ. The reporting person owned 68.82858 shares of CJ that were converted to 442,891 shares of ESA.
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(
2)
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This filing is to correct the number of shares sold, as erroneously reported on December 28, 2010 as 21,500 shares.
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(
3)
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This filing is to correct the number of shares sold, as erroneously report on January 3, 2011 as 4,661 shares.
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(
4)
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The reporting person acquired 9,049 shares of common stock pursuant to an exchange offer whereby 8 1/2 warrants were exchanged for one share of common stock.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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REYNOLDS DOUGLAS V
100 INDUSTRIAL LANE
HUNTINGTON, WV 25702
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X
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Signatures
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/s/ Alan Schick, Pursuant to Power of Attorney
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2/27/2012
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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