UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Subordinated Units (limited partner interests) | Â (1) | Â (1) | Common Units | 4,526,066 | $ 0 | D (2) (3) | Â |
Series A Convertible Preferred Units | Â (4) | Â (4) | Common Units | 5,142,857 | $ (4) | D (2) (3) | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
High Point Infrastructure Partners, LLC C/O ARCLIGHT CAPITAL PARTNERS, LLC 200 CLARENDON STREET, 55TH FLOOR BOSTON, MA 02117 |
 X |  X |  | See Remarks |
American Midstream GP, LLC C/O ARCLIGHT CAPITAL PARTNERS, LLC 200 CLARENDON STREET, 55TH FLOOR BOSTON, MA 02117 |
 X |  |  | See Remarks |
BERGSTROM STEPHEN W C/O ARCLIGHT CAPITAL PARTNERS, LLC 200 CLARENDON STREET, 55TH FLOOR BOSTON, MA 02117 |
 X |  |  Executive Chairman |  |
Revers Daniel R C/O ARCLIGHT CAPITAL PARTNERS, LLC 200 CLARENDON STREET, 55TH FLOOR BOSTON, MA 02117 |
 X |  |  |  |
Erhard Jake F C/O ARCLIGHT CAPITAL PARTNERS, LLC 200 CLARENDON STREET, 55TH FLOOR BOSTON, MA 02117 |
 X |  |  |  |
Taylor Lucius H. C/O ARCLIGHT CAPITAL PARTNERS, LLC 200 CLARENDON STREET, 55TH FLOOR BOSTON, MA 02117 |
 X |  |  |  |
/s/ Christine M. Miller, Secretary of High Point Infrastructure Partners, LLC | 04/25/2013 | |
**Signature of Reporting Person | Date | |
/s/ William B. Mathews, Senior Vice President, General Counsel and Secretary of American Midstream GP, LLC | 04/25/2013 | |
**Signature of Reporting Person | Date | |
/s/ William B. Mathews, attorney-in-fact for Stephen W. Bergstrom | 04/25/2013 | |
**Signature of Reporting Person | Date | |
/s/ Daniel R. Revers | 04/25/2013 | |
**Signature of Reporting Person | Date | |
/s/ Jake F. Erhard | 04/25/2013 | |
**Signature of Reporting Person | Date | |
/s/ Lucius H. Taylor | 04/25/2013 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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). |
(1) | Each subordinated unit will convert into one common unit at the end of the subordination period described in the Registration Statement. The subordinated units have no expiration date. |
(2) | On April 15, 2013, High Point acquired beneficial ownership of all of the Issuer's 5,142,857 outstanding Series A Convertible Preferred Units pursuant to the Contribution Agreement, dated as of April 15, 2013, between the Issuer and High Point. In addition, on April 15, 2013, High Point acquired beneficial ownership of all of the Issuer's 4,526,066 outstanding Subordinated Units pursuant to the Purchase Agreement, dated as of April 15, 2013, between AIM Midstream Holdings, LLC and High Point. Each of Messrs. Bergstrom, Revers, Erhard and Taylor (collectively, the "Director Reporting Persons") is a member of the board of directors of the General Partner. (continued on footnote 3) |
(3) | In addition, each of the Director Reporting Persons is a member of the general partner of ArcLight Energy Partners Fund V, L.P., the indirect majority owner of High Point, and therefore may be deemed a member of a group beneficially owning 10% or more of the equity of the Issuer within the meaning of Section 13(d) of the Securities Exchange Act of 1934, as amended. Each of the Director Reporting Persons disclaims beneficial ownership of these securities except to the extent of the reporting person's pecuniary interest, if any, in such securities through ownership in ArcLight Energy Fund V, L.P. and this report shall not be deemed an admission that such a group exists or that the reporting person is the beneficial owner of the securities of such group for purposes of Section 16 or for any other purpose. |
(4) | The Series A Convertible Preferred Units are convertible in whole or in part into Common Units at any time after January 1, 2014 or, prior to that date, with the consent of the required lenders under the Issuer's credit agreement, at the reporting person's election. The number of Common Units into which a Series A Preferred Unit is convertible will be an amount equal to (i) the sum of $17.50 and all accrued and accumulated but unpaid distributions, divided by (ii) the conversion price, which is initially $17.50, subject to customary anti-dilution adjustments. The Series A Convertible Preferred Units have no expiration date. |
 Remarks: High Point Infrastructure Partners, LLC ("High Point") also owns all of the Class A membership interests, representing 90% of all membership interests, in American Midstream GP, LLC, the general partner of the Issuer (the "General Partner"). The General Partner holds a 2% general partner interest in the Issuer, as well as the incentive distribution rights. Incentive distribution rights represent the right to receive an increasing percentage of quarterly distributions as set forth in the Issuer's Registration Statement on Form S-1 (Registration No. 333-173191) (the "Registration Statement"). |