UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Units of PBF Energy | Â (2) | Â (2) | Class A Common Stock | 8,753,649.9 | $ (2) | I | See footnotes (1) (2) (3) (4) (6) (7) (8) |
Series A Units of PBF Energy | Â (2) | Â (2) | Class A Common Stock | 26,657,519.6 | $ (2) | I | See footnotes (1) (2) (3) (5) (6) (7) (8) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
First Reserve GP XII Ltd ONE LAFAYETTE PLACE GREENWICH, CT 06830 |
 |  X |  |  |
FR PBF Holdings LLC ONE LAFAYETTE PLACE GREENWICH, CT 06830 |
 |  X |  |  |
FR PBF Holdings II LLC ONE LAFAYETTE PLACE GREENWICH, CT 06830 |
 |  X |  |  |
FR XII PBF Holdings LLC ONE LAFAYETTE PLACE GREENWICH, CT 06830 |
 |  X |  |  |
FR XII PBF AIV, L.P. ONE LAFAYETTE PLACE GREENWICH, CT 06830 |
 |  X |  |  |
FR XII-A PBF AIV, L.P. ONE LAFAYETTE PLACE GREENWICH, CT 06830 |
 |  X |  |  |
First Reserve GP XII, LP ONE LAFAYETTE PLACE GREENWICH, CT 06830 |
 |  X |  |  |
MACAULAY WILLIAM E ONE LAFAYETTE PLACE GREENWICH, CT 06830 |
 |  X |  |  |
FR PBF HOLDINGS LLC, By: FR XII PBF Holdings LLC, its Sole Member, By: /s/ Anne E. Gold, Anne E. Gold, CCO, Secretary | 12/13/2012 | |
**Signature of Reporting Person | Date | |
FR PBF HOLDINGS II LLC, By: FR XII PBF Holdings LLC, its Sole Member, By: /s/ Anne E. Gold, Anne E. Gold, CCO, Secretary | 12/13/2012 | |
**Signature of Reporting Person | Date | |
FR XII PBF HOLDINGS LLC, By: /s/ Anne E. Gold, Anne E. Gold, CCO, Secretary | 12/13/2012 | |
**Signature of Reporting Person | Date | |
FR XII PBF AIV, L.P., By: First Reserve GP XII, L.P., its general partner, By: First Reserve GP XII Limited, its general partner, By: /s/ Anne E. Gold, Anne E. Gold, CCO, Secretary | 12/13/2012 | |
**Signature of Reporting Person | Date | |
FR XII-A PBF AIV, L.P., By: First Reserve GP XII, L.P., its general partner, By: First Reserve GP XII Limited, its general partner, By: /s/ Anne E. Gold, Anne E. Gold, CCO, Secretary | 12/13/2012 | |
**Signature of Reporting Person | Date | |
FIRST RESERVE GP XII, L.P., By: First Reserve GP XII Limited, its general partner, By: /s/ Anne E. Gold, Anne E. Gold, CCO, Secretary | 12/13/2012 | |
**Signature of Reporting Person | Date | |
FIRST RESERVE GP XII LIMITED, By: /s/ Anne E. Gold, Anne E. Gold, CCO, Secretary | 12/13/2012 | |
**Signature of Reporting Person | Date | |
/s/ Anne E. Gold, Anne E. Gold, as attorney-in-fact for WILLIAM E. MACAULAY | 12/13/2012 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The Class B Common Stock of PBF Energy Inc. (the "Issuer") entitles the Reporting Person directly holding such share to one vote for each series A unit of PBF Energy Company LLC (the "PBF LLC Series A Units") held by such Reporting Person. |
(2) | Consists entirely of outstanding PBF LLC Series A Units. Pursuant to an exchange agreement the Series A Units of PBF Energy Company LLC are exchangeable at any time for shares of Class A common stock, $0.001 par value per share (the "Common Stock") of PBF Energy Inc. (the "Issuer") on a one-for-one basis, subject to equitable adjustments for stock splits, stock dividends and reclassifications. As the Reporting Person exchanges the Series A Units of PBF Energy Company LLC for shares of Class A Common Stock of PBF Energy Inc. pursuant to the exchange agreement, the voting power afforded to the Reporting Person by its share of Class B Common Stock of PBF Energy Inc. will be automatically and correspondingly reduced. |
(3) | The First Reserve Vehicles (as hereinafter defined) are comprised of FR PBF Holdings LLC and FR PBF Holdings II LLC (the "First Reserve Vehicles"). |
(4) | Represents securities which are directly held by FR PBF Holdings LLC. |
(5) | Represents securities which are directly held by FR PBF Holdings II LLC. |
(6) | FR XII PBF Holdings LLC is the sole member of each of the First Reserve Vehicles. FR XII PBF AIV, L.P. ("FR XII") and FR XII-A PBF AIV, L.P. ("FR XII-A") are the managing members of FR XII PBF Holdings LLC. First Reserve GP XII, L.P. is the general partner of FR XII and FR XII-A. First Reserve GP XII Limited is the general partner of First Reserve GP XII, L.P. William E. Macaulay is a director of First Reserve GP XII Limited and has the right to appoint a majority of the directors of its board. |
(7) | Information with respect to each of the Reporting Persons is given solely by such Reporting Person, and no Reporting Person has responsibility for the accuracy or completeness of information supplied by another Reporting Person. |
(8) | Each of such Reporting Persons may be deemed to beneficially own the securities beneficially owned by the First Reserve Vehicles directly or indirectly controlled by it or him, but each of the Reporting Persons, other than the First Reserve Vehicles as to their direct holdings of securities, disclaims beneficial ownership of the securities held by the First Reserve Vehicles except to the extent of such Reporting Person's pecuniary interest therein, and, pursuant to Rule 16a-1(a)(4) under the Securities Exchange Act of 1934, each of the Reporting Persons, other than the First Reserve Vehicles as to their direct holdings of securities, states that the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of all of the reported securities for purposes of Section 16 of the Securities Exchange Act of 1934 or for any other purpose. |
 Remarks: Exhibit List: Exhibit 24 - Power of Attorney |