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*
Inergy GP, LLC

(Last) (First) (Middle)
TWO BRUSH CREEK BOULEVARD
SUITE 200

(Street)
KANSAS CITY MO 64112

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
INERGY MIDSTREAM, L.P. [ NRGM ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
GP of NRGY
3. Date of Earliest Transaction (Month/Day/Year)
06/18/2013
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 06/18/2013 J(1) 56,398,707 D $0 0 I See Footnotes(1)(2)
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*
Inergy GP, LLC

(Last) (First) (Middle)
TWO BRUSH CREEK BOULEVARD
SUITE 200

(Street)
KANSAS CITY MO 64112

(City) (State) (Zip)
1. Name and Address of Reporting Person*
INERGY L P

(Last) (First) (Middle)
TWO BRUSH CREEK BOULEVARD
SUITE 200

(Street)
KANSAS CITY MO 64112

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Inergy Holdings GP, LLC

(Last) (First) (Middle)
TWO BRUSH CREEK BLVD.
SUITE 200

(Street)
KANSAS CITY MO 64112

(City) (State) (Zip)
1. Name and Address of Reporting Person*
INERGY HOLDINGS, L.P.

(Last) (First) (Middle)
TWO BRUSH CREEK BLVD.
SUITE 200

(Street)
KANSAS CITY MO 64112

(City) (State) (Zip)
Explanation of Responses:
1. Pursuant to the Contribution Agreement, dated as of May 5, 2013, among Crestwood Gas Services Holdings LLC, a Delaware limited liability company, Crestwood Holdings LLC, a Delaware limited liability company, Inergy, L.P., a Delaware limited partnership ("Inergy") and Inergy GP, LLC, a Delaware limited liability company, on June 18, 2013, Inergy distributed all of the common units held by it in Inergy Midstream, L.P. to the Inergy unitholders as of the record date of June 14, 2013. Each Inergy unitholder of record on the record date of June 14, 2013, received 0.432052 Inergy Midstream, L.P. common units for each Inergy unit representing limited partner interests held by such unitholder. No fractional Inergy Midstream, L.P. common units were distributed.
2. This Form 4 is jointly filed by Inergy, L.P. ("NRGY"), Inergy GP, LLC, Inergy Holdings, L.P. and Inergy Holdings GP, LLC.
Judy R. Riddle (attorney-in-fact) for John J. Sherman, President and CEO of Inergy GP, LLC on behalf of Inergy, L.P. 06/18/2013
Judy R. Riddle (attorney-in-fact) for John J. Sherman, President and CEO of Inergy Holdings GP, LLC on behalf of Inergy Holdings, L.P. 06/18/2013
Judy R. Riddle (attorney-in-fact) for John J. Sherman, President and CEO of Inergy Holdings GP, LLC 06/18/2013
Judy R. Riddle (attorney-in-fact) for John J. Sherman, President and CEO of Inergy GP, LLC 06/18/2013
** 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).
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