Form 3 Phillips 66 For: Jul 14 Filed by: Terreson Douglas T
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| 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
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person
*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year)
07/14/2021
|
3. Issuer Name
and
Ticker or Trading Symbol
Phillips 66
[
PSX
]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
|
10% Owner |
|
Officer (give title below) |
|
Other (specify below) |
|
|
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)
|
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 |
| Explanation of Responses: |
|
Amanda K. Maki, Attorney-in-Fact |
07/16/2021 |
|
** 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
4
(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. |
POWER OF ATTORNEY
The undersigned, a person subject to ownership reporting pursuant to Section 16(a) of the
Securities Exchange Act of 1934, as amended (the "Exchange Act"), and requirements pursuant to
Rule 144 under the Securities Act of 1933, as amended (the "Securities Act"), in respect of the equity
securities of Phillips 66, hereby makes, constitutes and appoints any of Amanda K. Maki, Julie P. Pradel,
Lisa D. Thompkins and Debra M. Green my true and lawful attorney-in-fact with full power and authority:
(1) to prepare, execute in my name and on my behalf, and file with the U.S. Securities and
Exchange Commission (the "SEC") any of the following forms which I may be required or permitted to file:
(A) Form ID and any other documents necessary or appropriate to obtain codes and
passwords enabling the undersigned to make electronic filings with the SEC of reports required
by Section 16(a) of the Exchange Act or any rule or regulation of the SEC;
(B) Forms 3, 4 and 5 or any other reports or statements of beneficial ownership or
changes of beneficial ownership necessary or appropriate under Section 16(a) of the Exchange
Act; and
(C) Form 144, or any other notice of proposed sale of securities or other document
necessary or appropriate under Rule 144 of the Securities Act.
(2) to do and perform any and all acts for and on my behalf which may be necessary or
desirable to complete and execute any such Form ID, 3, 4, 5, or 144, complete and execute any
amendment or amendments thereto, and timely file such form with the SEC and any stock exchange or
similar authority
I hereby revoke any previous power of attorney I may have given to any person to make and file
such reports, statements and notices with respect to the equity securities of Phillips 66. This power
of attorney shall remain in force for so long as I may be subject to reporting obligations under
Section 16(a) of the Exchange Act or the requirements of Rule 144 under the Securities Act, unless earlier
expressly revoked by me in writing and delivered to Phillips 66. Each of my attorneys-in-fact may at
their sole discretion designate one or more substitute attorneys-in-fact to act in their place. I acknowledge
that my attorneys-in-fact, in serving in this capacity at my request, are not assuming, nor is
Phillips 66 assuming, any of my responsibilities to comply with the Exchange Act, the Securities
Act, or the rules and regulations thereunder.
/s/ Douglas T. Terreson
Douglas T. Terreson
Date: July 9, 2021
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