TRANSACTION VALUATION* | AMOUNT OF FILING FEE* | ||||
$3,360,547 |
$187.52 | ||||
* | Calculated solely for purposes of determining the filing fee. This amount assumes that options to purchase 1,663,637 shares of common stock of Delek US Holdings, Inc. having an aggregate value of approximately $3,360,547 as of May 11, 2009, will be surrendered and/or cancelled pursuant to this offer. The aggregate value of such options was calculated based on a Black-Scholes valuation model. The amount of the filing fee, calculated in accordance with Rule 0-11 of the Securities Exchange Act of 1934, as amended, equals $55.80 per million dollars of the value of the transaction. |
þ | Check box if any part of the fee is offset as provided by Rule 0-11(a)(2) and identify the filing with which the offsetting fee was previously paid. Identify the previous filing by registration statement number, or the Form or Schedule and the date of its filing. |
Amount Previously Paid:
|
$187.52 | Filing party: | Delek US Holdings, Inc. | |||
Form or Registration No.:
|
Schedule TO-I | Date Filed: | May 13, 2009 |
o | Check the box if the filing relates solely to preliminary communications made before the commencement of a tender offer. |
o | third-party tender offer subject to Rule 14d-1 | ||
þ | issuer tender offer subject to Rule 13e-4 | ||
o | going private transaction subject to Rule 13e-3 | ||
o | amendment to Schedule 13D under Rule 13d-2 |
o | Rule 13d-4(i) (Cross-Border Issuer Tender Offer) | ||
o | Rule 14d-1(d) (Cross-Border Third-Party Tender Offer) |
Item 4. Terms of the Transaction | ||||||||
Item 12. Exhibits | ||||||||
SIGNATURE | ||||||||
INDEX TO EXHIBITS | ||||||||
EX-99.A.1.XV |
(a)(1)(xv)*
|
Form of E-mail/Letter Announcing Final Results of Option Exchange Program. |
* | Filed herewith |
Dated: June 12, 2009 | DELEK US HOLDINGS, INC. |
|||
By: | /S/ EZRA UZI YEMIN | |||
Ezra Uzi Yemin | ||||
President, Chief Executive Officer and Director |
(a)(1)(i)+
|
Offering Memorandum relating to our Offer to Exchange Certain Outstanding Options to Purchase Common Stock for Replacement Options to Purchase Common Stock, dated May 13, 2009. | |
(a)(1)(ii)+
|
Introductory E-mail to All Eligible Option Holders from Kathy Roadarmel, dated May 13, 2009. | |
(a)(1)(iii)+
|
Summary of Stock Option Exchange Program. | |
(a)(1)(iv)+
|
Form of E-mail Announcement of Option Exchange Offer, dated May 13, 2009. | |
(a)(1)(v)+
|
Election Form. | |
(a)(1)(vi)+
|
Screen Shots of Offer Website. | |
(a)(1)(vii)+
|
Form of Confirmation E-mails concerning Receipt of Election Form. | |
(a)(1)(viii)+
|
Form of Reminder E-mail. | |
(a)(1)(ix)+
|
Instructions Form Part of the Terms and Conditions of the Offer. | |
(a)(1)(x)+
|
Agreement to Terms of Election. | |
(a)(1)(xi)
|
Delek US Holdings, Inc.s Annual Report on Form 10-K for the fiscal year ended December 31, 2008, filed with the Securities and Exchange Commission on March 9, 2009 and incorporated herein by reference. | |
(a)(1)(xii)
|
Delek US Holdings, Inc.s Quarterly Report on Form 10-Q for the quarterly period ended March 31, 2009, filed with the Securities and Exchange Commission on May 11, 2009 and incorporated herein by reference. | |
(a)(1)(xiii)+
|
Amendment to Offering Memorandum Relating to our Offer to Exchange Certain Outstanding Options to Purchase Common Stock for Replacement Options to Purchase Common Stock, dated May 21, 2009. | |
(a)(1)(xiv)+
|
Form of E-mail/Letter Announcing Extension of the Offer. | |
(a)(1)(xv)*
|
Form of E-mail/Letter Announcing Final Results of Option Exchange Program. | |
(a)(2)
|
Not applicable. | |
(a)(3)
|
Not applicable. | |
(a)(4)
|
Delek US Holdings, Inc.s Registration Statement on Form S-8 (File No. 333-134495), filed with the Securities and Exchange Commission on May 26, 2006 and incorporated herein by reference. | |
(a)(5)
|
Delek US Holdings, Inc.s Definitive Proxy Statement on Schedule 14A, filed with the Securities and Exchange Commission on April 3, 2009 and incorporated herein by reference. | |
(b)
|
Not applicable. |
(d)(i)
|
Delek US Holdings, Inc. 2006 Long-Term Incentive Plan is incorporated herein by reference to Exhibit 10.13 of Delek US Holdings, Inc.s Registration Statement on Form S-1/A (File No. 333-131675), filed with the Securities and Exchange Commission on April 20, 2006. | |
(d)(ii)
|
Director Form of Stock Option Agreement pursuant to the Delek US Holdings, Inc. 2006 Long-Term Incentive Plan is incorporated herein by reference to Exhibit 10.13(b) of Delek US Holdings, Inc.s Registration Statement on Form S-1/A (File No. 333-131675), filed with the Securities and Exchange Commission on April 20, 2006. | |
(d)(iii)
|
Officer Form of Stock Option Agreement pursuant to the Delek US Holdings, Inc. 2006 Long-Term Incentive Plan is hereby incorporated by reference to Exhibit 10.13(c) of Delek US Holdings, Inc.s Registration Statement on Form S-1/A (File No. 333-131675), filed with the Securities and Exchange Commission on April 20, 2006. | |
(g)
|
Not applicable. | |
(h)
|
Not applicable. |
+ | Previously filed | |
* | Filed herewith |