SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
Yates Jim

(Last) (First) (Middle)
825 TOWN AND COUNTRY LANE, SUITE 1500

(Street)
HOUSTON TX 77024

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/15/2022
3. Issuer Name and Ticker or Trading Symbol
PAR PACIFIC HOLDINGS, INC. [ PARR ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Executive Vice President
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 73,197 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Common stock (right to buy) (1) 02/18/2029 Common Stock 37,591 $16.52 D
Common stock (right to buy) (2) 02/20/2028 Common Stock 28,016 $19.73 D
Common stock (right to buy) (3) 02/25/2027 Common Stock 28,644 $17 D
Common stock (right to buy) (4) 02/26/2026 Common Stock 13,766 $17.34 D
Common stock (right to buy) (5) 02/27/2025 Common Stock 16,439 $14.6 D
Common stock (right to buy) (6) 02/15/2024 Common Stock 9,787 $22.99 D
Common stock (right to buy) (7) 05/07/2023 Common Stock 8,625 $23.49 D
Explanation of Responses:
1. One fourth of the shares will vest on each of the first, second, third and fourth anniversaries of the grant date of 2/19/2021.
2. One fourth of the shares will vest on each of the first, second, third and fourth anniversaries of the grant date of 2/21/2020.
3. One fourth of the shares will vest on each of the first, second, third and fourth anniversaries of the grant date of 2/26/2019.
4. One fourth of the shares will vest on each of the first, second, third and fourth anniversaries of the grant date of February 27, 2018.
5. One fourth of the shares will vest on each of the first, second, third and fourth anniversaries of the grant date of February 28, 2017.
6. One fourth of the shares will vest on each of the first, second, third and fourth anniversaries of the grant date of February 16, 2016.
7. One third of the shares will vest on each of the first, second and third anniversaries of the grant date of May 8, 2015
Remarks:
/s/ Jim Yates 11/09/2022
** 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 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.