SEC Form 4/A · accession 0001351541-17-000086
Delek US Holdings, Inc. · DK
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
This is an amendment (Form 4/A). It replaces an earlier filing for the same period.
Reporting owner
Daniel L Gordon
Officer — Executive Vice President
Period of report
Mar 7, 2017
Accepted (ET)
Mar 20, 2017 · 7:21 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001351541
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Mar 7, 2017 | M | 8,125 | $11.58 | A | 30,456 | D | |
| Common StockF2 | Mar 7, 2017 | D | 3,766 | $24.99 | D | 26,690 | D | |
| Common StockF3 | Mar 7, 2017 | F | 1,340 | $24.99 | D | 25,350 | D | |
| Common StockF1,F4 | Mar 7, 2017 | S | 3,019 | $24.7461 | D | 22,331 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Appreciation RightF1,F5 | $11.58 | Mar 7, 2017 | M | 8,125 | D | — | Mar 10, 2021 | Common Stock | 8,125 | 0 | D |
Explanation of responses
- F1This amendment is being filed to amend the Form 4 filed by the reporting person on March 7, 2017 (the "Original Form") to clarify that the reported 3,019 shares of Common Stock sold on March 7, 2017 were acquired upon exercise of a stock appreciation right on the same date and to correct the number of shares beneficially owned following such exercise in column 5 of Table I. The number of shares of Common Stock was also incorrectly reported in column 5 of Table I of the subsequent Forms 4 filed by the reporting person on March 8, 2017 and March 14, 2017.
- F2This amendment is being filed to also report the disposition of shares of Common Stock to Delek US Holdings, Inc. for payment of the exercise price in connection with the exercise of the stock appreciation right that was not previously reported in the Original Form 4.
- F3This amendment is being filed to also report the shares withheld to cover tax withholding obligations in connection with the exercise of the stock appreciation right that was not previously reported in the Original Form 4.
- F4The price reflects the weighted average sale price of multiple transactions ranging from a low sale price of $24.59 per share to a high sale price of $24.78 per share. Upon the written request of the SEC, the issuer or a security holder of the issuer, the reporting person agrees to provide the number of shares sold at each sale price.
- F5The stock appreciation right vested with respect to 8,125 shares of Common Stock on each of March 10, 2012, March 10, 2013, March 10, 2014 and March 10, 2015.