0001209191-16-093260.txt : 20160122 0001209191-16-093260.hdr.sgml : 20160122 20160122175142 ACCESSION NUMBER: 0001209191-16-093260 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160120 FILED AS OF DATE: 20160122 DATE AS OF CHANGE: 20160122 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Northern Tier Energy LP CENTRAL INDEX KEY: 0001533454 STANDARD INDUSTRIAL CLASSIFICATION: PETROLEUM REFINING [2911] IRS NUMBER: 800763623 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1250 W. WASHINGTON STREET STREET 2: SUITE 300 CITY: TEMPE STATE: AZ ZIP: 85281 BUSINESS PHONE: (602) 302-5450 MAIL ADDRESS: STREET 1: 1250 W. WASHINGTON STREET STREET 2: SUITE 300 CITY: TEMPE STATE: AZ ZIP: 85281 FORMER COMPANY: FORMER CONFORMED NAME: Northern Tier Energy, Inc. DATE OF NAME CHANGE: 20111025 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: 001-35612 FILM NUMBER: 161357097 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 2016-01-20 0 0001533454 Northern Tier Energy LP NTI 0001358598 Davis Karen Berriman C/O NORTHERN TIER ENERGY LP 1250 W. WASHINGTON STREET, SUITE 300 TEMPE AZ 85281 0 1 0 0 Exec VP, CFO Common Unit 2016-01-20 4 M 0 5159 0.00 A 5159 D Common Unit 2016-01-20 4 S 0 1693 24.3274 D 3466 D Phantom Unit 2016-01-20 4 M 0 5159 0.00 D Common Units 5159 10317 D Phantom Unit 2016-01-20 4 A 0 13636 0.00 A Common Units 13636 23953 D These common units were issued pursuant to a phantom unit award granted to the reporting person on February 2, 2015 (the "2015 Phantom Unit Award"), settled, at the election of the Compensation Committee of the Board of Directors (the "Board") of Northern Tier Energy GP LLC ("NTI GP"), the general partner of NTI, in NTI common units. This sale was made pursuant to a previous election made by the reporting person for the payment of income taxes required to be paid to the Internal Revenue Service as a result of the vesting of the 2015 Phantom Unit Award previously granted to the reporting person as compensation for services as an officer. The reporting person hereby undertakes to provide upon request by the SEC staff, the issuer, or any security holder of the issuer, full information regarding the number of common units sold at each separate price. $24.3274 is the weighted average sale price. The shares were sold in various transactions through a broker at prices between $24.2300 per share and $24.4700 per share. Each phantom unit represents a contingent right to receive one common unit representing a limited partner interest in NTI or, at the election of the Board, or such Committee as may be appointed by the Board, the cash value thereof. The phantom units were awarded as compensation for services as an officer of NTI GP. The phantom units vest ratably on the third Wednesday of January in each of the three years following the date of grant. The vested common units underlying the phantom units, or the cash value thereof, will be delivered to the reporting person on or promptly following the vesting date applicable thereto, but not later than the 70th calendar day following the vesting of the phantom units. This number of derivative securities includes 10,317 phantom units that remain outstanding pursuant to the 2015 Phantom Unit Award. This number of derivative securities includes (a) 10,317 phantom units that remain outstanding pursuant to the 2015 Phantom Unit Award; and (b) 13,636 phantom units that remain outstanding pursuant to a phantom unit award granted to the reporting person on January 20, 2016. s/ Karen B. Davis 2016-01-22