0001209191-23-054873.txt : 20231109
0001209191-23-054873.hdr.sgml : 20231109
20231109170913
ACCESSION NUMBER: 0001209191-23-054873
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20231108
FILED AS OF DATE: 20231109
DATE AS OF CHANGE: 20231109
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kostelnik Robert J.
CENTRAL INDEX KEY: 0001507989
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41325
FILM NUMBER: 231393685
MAIL ADDRESS:
STREET 1: 10000 MEMORIAL DRIVE, SUITE 600
CITY: HOUSTON
STATE: TX
ZIP: 77024-3411
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: HF Sinclair Corp
CENTRAL INDEX KEY: 0001915657
STANDARD INDUSTRIAL CLASSIFICATION: PIPE LINES (NO NATURAL GAS) [4610]
IRS NUMBER: 872092143
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2828 N. HARWOOD
STREET 2: SUITE 1300
CITY: DALLAS
STATE: TX
ZIP: 75201
BUSINESS PHONE: 214-954-6696
MAIL ADDRESS:
STREET 1: 2828 N. HARWOOD
STREET 2: SUITE 1300
CITY: DALLAS
STATE: TX
ZIP: 75201
FORMER COMPANY:
FORMER CONFORMED NAME: Hippo Parent Corp
DATE OF NAME CHANGE: 20220307
4
1
doc4.xml
FORM 4 SUBMISSION
X0508
4
2023-11-08
0
0001915657
HF Sinclair Corp
DINO
0001507989
Kostelnik Robert J.
2828 N. HARWOOD, STE 1300
DALLAS
TX
75201
1
0
0
0
0
Common Stock
2023-11-08
4
A
0
3005
0.00
A
52883
D
Restricted stock units granted under the HF Sinclair Corporation Amended and Restated 2020 Long Term Incentive Plan. The restricted stock units are subject to restrictions that will lapse on December 1, 2024 (or on the first business day thereafter if such date falls on a weekend), provided the reporting person has served on the board of directors of the Issuer from the grant date until such vesting date. Unless settlement is deferred pursuant to the Issuer's deferred compensation arrangement for directors, the vested restricted stock units will be paid within 30 days following the vesting date in the form of the Issuer's common stock equal to the number of vested restricted stock units.
Exhibit List: Exhibit 24 - Power of Attorney
Stacey L. Foland
Attorney-in-Fact
2023-11-09
EX-24
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
For Executing Form ID, Form 3, Form 4, Form 5, Form144 and
Schedule 13D and Schedule 13G
The undersigned hereby constitutes and appoints each of Vaishali S. Bhatia and
Stacey L. Foland, signing singly, with full power of substitution, as the
undersigned's true and lawful attorney-in-fact to:
(1) Prepare and execute for and on behalf of the undersigned a Form ID
(Application for Edgar Access) (including amendments thereto); or any other
forms prescribed by the Securities and Exchange Commission, that may be
necessary to obtain codes and passwords enabling the undersigned to make
electronic filings with the Securities and Exchange Commission of the forms
referenced in clause (2) below;
(2) Prepare and execute for and on behalf of the undersigned any: (a) Form 3,
Form 4, and Form 5 (including amendments thereto) in accordance with Section
16(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act");
(b) Form 144 (including amendments thereto); and (c) Schedule 13D and Schedule
13G (including amendments thereto) in accordance with Sections 13(d) and 13(g)
of the Exchange Act, but only to the extent each form or schedule relates to the
undersigned's beneficial ownership of securities of HF Sinclair Corporation or
any of its subsidiaries;
(3) Do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to complete and execute any Form ID, Form 3, Form
4, Form 5, Form 144, Schedule 13D or Schedule 13G (including amendments thereto)
and timely file the forms or schedules with the Securities and Exchange
Commission and any stock exchange or quotation system, self-regulatory
association or any other authority, and provide a copy as required by law or
advisable to such persons as the attorney-in-fact deems appropriate; and
(4) Take any other action in connection with the foregoing that, in the opinion
of the attorney-in-fact, may be of benefit to, in the best interest of, or
legally required of the undersigned, it being understood that the documents
executed by the attorney-in-fact on behalf of the undersigned pursuant to this
Power of Attorney shall be in such form and shall contain such terms and
conditions as the attorney-in-fact may approve in the attorney-in-fact's
discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform all and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Power of Attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorneys-in-fact, and
their substitutes, in serving in such capacity at the request of the
undersigned, are not assuming, nor is HF Sinclair Corporation or any of its
subsidiaries assuming, (i) any of the undersigned's responsibilities to comply
with Section 16 or Sections 13(d) or 13(g) of the Exchange Act or (ii) any
liability of the undersigned for failure to comply with such requirements. This
Power of Attorney does not relieve the undersigned from the undersigned's
obligations to comply with the requirements of the Exchange Act, including
without limitation the reporting requirements under Section 16 or Sections 13(d)
or 13(g) thereunder.
The undersigned agrees that each such attorney-in-fact may rely entirely on
information furnished orally or in writing by or at the direction of the
undersigned to the attorney-in-fact. The undersigned also agrees to indemnify
and hold harmless HF Sinclair Corporation and its subsidiaries and each such
attorney-in-fact against any losses, claims, damages or liabilities (or actions
in these respects) that arise out of or are based upon any untrue statements or
omissions of necessary facts in the information provided by or at the direction
of the undersigned, or upon the lack of timeliness in the delivery of
information by or at the direction of the undersigned, to such attorney-in-fact
for purposes of executing, acknowledging, delivering or filing a Form ID, Form
3, Form 4, Form 5, Form 144, Schedule 13D or Schedule 13G (including amendments
thereto) and agrees to reimburse HF Sinclair Corporation and its subsidiaries
and such attorney-in-fact on demand for any legal or other expenses reasonably
incurred in connection with investigating or defending against any such loss,
claim, damage, liability or action.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Form ID, Form 3, Form 4, Form 5, Form
144, Schedule 13D and Schedule 13G (including amendments thereto) with respect
to the undersigned's holdings of and transactions in securities issued by HF
Sinclair Corporation or any of its subsidiaries, unless earlier revoked by the
undersigned in a signed writing delivered to the foregoing attorneys-in-fact.
This Power of Attorney does not revoke any other power of attorney that the
undersigned has previously granted.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of the date written below.
/s/ Robert J. Kostelnik
Robert J. Kostelnik
November 8, 2023