SEC FORM 4/A SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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: 3235-0287
Estimated average burden
hours per response: 0.5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
OCCIDENTAL PETROLEUM CORP /DE/

(Last) (First) (Middle)
10889 WILSHIRE BOULEVARD

(Street)
LOS ANGELES CA 90024

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
PREMCOR USA INC [ PCO ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
01/06/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
01/07/2004
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock option (right to buy) $26.14 01/06/2004 A(1) 2,500 (2) 01/06/2014 Common Stock 2,500 $0 2,500 I by subsidiary(3)
1. Name and Address of Reporting Person*
OCCIDENTAL PETROLEUM CORP /DE/

(Last) (First) (Middle)
10889 WILSHIRE BOULEVARD

(Street)
LOS ANGELES CA 90024

(City) (State) (Zip)
1. Name and Address of Reporting Person*
OCCIDENTAL C O B PARTNERS

(Last) (First) (Middle)
110 WEST 7TH STREET
P.O. BOX 300

(Street)
TULSA OK 74102

(City) (State) (Zip)
1. Name and Address of Reporting Person*
PLACID OIL CO

(Last) (First) (Middle)
10889 WILSHIRE BOULEVARD

(Street)
LOS ANGELES CA 90024

(City) (State) (Zip)
1. Name and Address of Reporting Person*
OXY USA INC

(Last) (First) (Middle)
5 GREENWAY PLAZA

(Street)
HOUSTON TX 77046

(City) (State) (Zip)
1. Name and Address of Reporting Person*
OCCIDENTAL OIL & GAS HOLDING CORP

(Last) (First) (Middle)
10889 WILSHIRE BOULEVARD

(Street)
LOS ANGELES CA 90024

(City) (State) (Zip)
1. Name and Address of Reporting Person*
OCCIDENTAL PETROLEUM INVESTMENT CORP

(Last) (First) (Middle)
10889 WILSHIRE BOULEVARD

(Street)
LOS ANGELES CA 90024

(City) (State) (Zip)
Explanation of Responses:
1. The option was granted pursuant to the Premcor Inc. Outside Director Compensation Program to Occidental C.O.B. Partners in lieu of its designee on the Premcor Board of Directors.
2. The option vests in five equal annual installments beginning on January 6, 2005.
3. Owned by Occidental C.O.B. Partners, an indirect wholly-owned subsidiary of Occidental Petroleum Corporation.
/s/ J. R. HAVERT, Vice President and Treasurer 01/14/2004
** 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.
FORM 4

JOINT FILER INFORMATION

 

Name: Occidental C.O.B. Partners
       
Address: 110 West 7th Street
P.O. Box 300
Tulsa, Oklahoma 74102
       
Designated Filer: Occidental Petroleum Corporation
       
Issuer & Ticker Symbol: Premcor Inc. (PCO)
       
Date of Event Requiring Statement: 01/06/2004
       
Signature: OCCIDENTAL C.O.B. PARTNERS
by OXY USA Inc., its managing partner
       
By:   /s/ STEPHEN I. CHAZEN
Stephen I. Chazen
Executive Vice President

 

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JOINT FILER INFORMATION

 

Name: Placid Oil Company
       
Address: 10889 Wilshire Boulevard
Los Angeles, California 90024
       
Designated Filer: Occidental Petroleum Corporation
       
Issuer & Ticker Symbol: Premcor Inc. (PCO)
       
Date of Event Requiring Statement: 01/06/2004
       
Signature: PLACID OIL COMPANY
       
By:   /s/ STEPHEN I. CHAZEN
Stephen I. Chazen
Executive Vice President

 

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JOINT FILER INFORMATION

 

Name: OXY USA Inc.
       
Address: 5 Greenway Plaza
Houston, Texas 77046
       
Designated Filer: Occidental Petroleum Corporation
       
Issuer & Ticker Symbol: Premcor Inc. (PCO)
       
Date of Event Requiring Statement: 01/06/2004
       
Signature: OXY USA INC.
       
By:   /s/ STEPHEN I. CHAZEN
Stephen I. Chazen
Executive Vice President

 

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JOINT FILER INFORMATION

 

Name: Occidental Oil and Gas Holding Corporation
       
Address: 10889 Wilshire Boulevard
Los Angeles, California 90024
       
Designated Filer: Occidental Petroleum Corporation
       
Issuer & Ticker Symbol: Premcor Inc. (PCO)
       
Date of Event Requiring Statement: 01/06/2004
       
Signature: OCCIDENTAL OIL AND GAS HOLDING CORPORATION
       
By:   /s/ STEPHEN I. CHAZEN
Stephen I. Chazen
Executive Vice President

 

Page 6 of 7

 


 

JOINT FILER INFORMATION

 

Name: Occidental Petroleum Investment Co.
       
Address: 10889 Wilshire Boulevard
Los Angeles, California 90024
       
Designated Filer: Occidental Petroleum Corporation
       
Issuer & Ticker Symbol: Premcor Inc. (PCO)
       
Date of Event Requiring Statement: 01/06/2004
       
Signature: OCCIDENTAL PETROLEUM INVESTMENT CO.
       
By:   /s/ J.R. HAVERT
J. R. Havert
Vice President and Treasurer

 

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