0001209191-17-000446.txt : 20170103 0001209191-17-000446.hdr.sgml : 20170103 20170103183038 ACCESSION NUMBER: 0001209191-17-000446 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161230 FILED AS OF DATE: 20170103 DATE AS OF CHANGE: 20170103 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Western Refining, Inc. CENTRAL INDEX KEY: 0001339048 STANDARD INDUSTRIAL CLASSIFICATION: PETROLEUM REFINING [2911] IRS NUMBER: 203472415 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 6500 TROWBRIDGE DRIVE CITY: EL PASO STATE: TX ZIP: 79905 BUSINESS PHONE: (915) 775-3488 MAIL ADDRESS: STREET 1: 6500 TROWBRIDGE DRIVE CITY: EL PASO STATE: TX ZIP: 79905 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Davis Karen Berriman CENTRAL INDEX KEY: 0001358598 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32721 FILM NUMBER: 17503157 MAIL ADDRESS: STREET 1: 123 WEST MILLS AVENUE STREET 2: SUITE 200 CITY: EL PASO STATE: TX ZIP: 79901 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-12-30 0 0001339048 Western Refining, Inc. WNR 0001358598 Davis Karen Berriman C/O WESTERN REFINING, INC. 123 W. MILLS AVENUE, SUITE 600 EL PASO TX 79901 0 1 0 0 EVP and CFO Common Stock 2016-12-30 4 M 0 10017 0.00 A 11051 D Common Stock 2016-12-30 4 F 0 4623 0.00 D 6428 D Phantom Stock 2016-12-30 4 M 0 10017 0.00 D Common Stock 10017 14709 D 10,017 shares were issued pursuant to a phantom stock award ("Phantom Stock Award") granted to the reporting person on June 23, 2016, which were settled at the election of the Compensation Committee of WNR's Board of Directors (the "Board") in WNR common stock. These shares of common stock were issuable upon vesting of the Phantom Stock Award, but were withheld to satisfy the reporting person's tax obligations. These shares of phantom stock represent a contingent right to receive one share of WNR common stock or, at the election of the Compensation Committee of the Board, the cash value thereof. These shares of phantom stock were issued as compensation for services as an officer of Issuer. These shares of phantom stock vested on December 30, 2016. This number of derivative securities include (a) 5,325 phantom stock shares that remain outstanding pursuant to a phantom stock award granted on June 23, 2016, and (b) 9,384 phantom stock shares that remain outstanding pursuant to a phantom stock award granted on June 23, 2016. /s/ Karen B. Davis 2017-01-03