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 | ||||
Option to Purchase Membership Interests (2) | 11/01/2005 | 05/04/2015 | Membership Interests | 150 | $ 2,000 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Rodney Don P 11 GREENWAY PLAZA, SUITE 2950 HOUSTON, TX 77046 |
 |  |  VP Finance, Hercules Drilling |  |
/s/ Steven A. Manz, attorney-in-fact | 10/26/2005 | |
**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) | To be converted into 41,650 shares of common stock, par value $0.01 per share, of Hercules Offshore, Inc. in the conversion of the Company from a limited liability company to a corporation prior to the closing of the Company's initial public offering. |
(2) | The option will become immediately exercisable for the purchase of 52,500 shares of common stock of Hercules Offshore, Inc. at an exercise price of $5.71 per share upon the occurrence of an IPO as that term is defined in the Hercules Offshore 2004 Long-term Incentive Plan. |
 Remarks: Exhibit List Exhibit 24 Power of Attorney |