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*
SUMMIT MIDSTREAM PARTNERS, LLC

(Last) (First) (Middle)
1790 HUGHES LANDING BLVD., SUITE 500

(Street)
THE WOODLANDS TX 77380

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Summit Midstream Partners, LP [ SMLP ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/15/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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
Common Units (Limited Partner Interests) 11/15/2019 A 10,714,285 A (1) 45,318,866 I BY: SUMMIT MIDSTREAM PARTNERS HOLDINGS, LLC
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
1. Name and Address of Reporting Person*
SUMMIT MIDSTREAM PARTNERS, LLC

(Last) (First) (Middle)
1790 HUGHES LANDING BLVD., SUITE 500

(Street)
THE WOODLANDS TX 77380

(City) (State) (Zip)
1. Name and Address of Reporting Person*
SUMMIT MIDSTREAM PARTNERS HOLDINGS, LLC

(Last) (First) (Middle)
1790 HUGHES LANDING BLVD., SUITE 500

(Street)
THE WOODLANDS TX 77380

(City) (State) (Zip)
Explanation of Responses:
1. On November 7, 2019, Summit Midstream Partners, LP (the "Partnership") and Summit Midstream Partners Holdings, LLC ("SMP Holdings") entered into a second amendment to that certain Contribution Agreement between SMP Holdings and the Partnership dated February 25, 2016, as amended, pursuant to which the Partnership made a cash payment of $51.75 million and issued 10,714,285 Common Units to SMP Holdings on November 15, 2019. The sole member of SMP Holdings is Summit Midstream Partners, LLC.
Remarks:
Summit Midstream Partners, LLC By: /s/ Brock M. Degeyter Title: Executive Vice President, General Counsel, and Chief Compliance Officer 02/07/2020
Summit Midstream Partners Holdings, LLC By: /s/ Brock M. Degeyter Title: Executive Vice President, General Counsel and Chief Compliance Officer 02/07/2020
** Signature of Reporting Person Date
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