Text

Enclosure a - Redacted Owners, Officers, Directors, and Executive Personnel Forms for Energy Harbor Corp., Energy Harbor Nuclear Corp., and Energy Harbor Nuclear Generation LLC
	ML20177A493
Person / Time
Site:	Beaver Valley, Davis Besse, Perry
Issue date:	06/25/2020
From:	; Energy Harbor Corp, Energy Harbor Nuclear Corp, Energy Harbor Nuclear Generation LLC
To:	; Office of Nuclear Security and Incident Response
Shared Package
ML20177A491	List: L-20-178, Submittal of Information Pertaining to Foreign Ownership, Control, or Influence; ML20177A493;
References
	L-20-178
	Download: ML20177A493 (16)
	v • d • e

Enclosure A L-20-178 Redacted Owners, Officers, Directors, and Executive Personnel Forms for Energy Harbor Corp., Energy Harbor Nuclear Corp.,

and Energy Harbor Nuclear Generation LLC (Fifteen pages follow)

Redacted Owners, Officers, Directors, and Executive Personnel Form for Energy Harbor Corp.

(Four pages follow)

List ALL Owners, Officers, Directors, and Executive Personnel (OODEP's)

NRC FORM 405F (12-2018)

U. S. NUCLEAR REGULATORY COMMISSION NRC FORM 405F (12-2018)

Company's Current Legal Name, Address, and Phone Number of Company's Principal Executive Offices:

Date Submitted:

Tax Identification No.

(Must provide any name or address change of the Company's principal executive office and date(s) of change during the past 10 years on the Attachment page).

Date Company was Incorporated:

State of Incorporation:

Organization Status:

Corporation Sole Proprietorship Partnership General Limited Other Stock Ownership:

Privately-Owned Publicly-Traded Subsidiary of:

NAME (First Name, Initial, Last Name)

POSITION TITLES IF OWNER,

% OF OWNERSHIP SSN CLEARANCE HELD AND/OR BEING OBTAINED AND ISSUING AGENCY CITIZENSHIP Other names used (e.g., doing business as):

Facility Security Officer The above information, i.e., name, titles, etc., must be provided for the following: (a) the proprietor of a sole proprietorship; (b) all individuals managing the business affairs of a corporation. In most cases, these individuals are identified in the Articles of Incorporation or By-Laws and include the Board of Directors, President, Secretary, and Treasurer; (c) the General Partner(s) of a Limited Partnership; and (d) all partners of a General Partnership. In addition, privately-held entities must provide the above information, i.e., name, titles, etc., for all owners, and also provide the percentage of issued stock/shares held by each owner.

List certified correct by: (Typed or Printed Name and Title)

SIGNATURE DATE OFFICIAL USE ONLY - SECURITY-RELATED INFORMATION 10 CFR Part 95 1

2 Estimated burden per response to comply with this collection request: 10 minutes. This collection is a voluntary means of complying with the requirements in 10 CFR 95.17. This notification is being made available to report changes to owners, officers, directors or executive personnel entities holding existing Facility Clearances under 10 CFR 95 or MD 12.2. Send comments regarding burden estimate to the Information Services Branch (O-1 F21), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.

Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0047), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

APPROVED BY OMB: 3150-0047 EXPIRES: 12/31/2018 NOTE: Consistent with Executive Order 12829 and the requirements in 10 CFR 95.18, individuals identified as Key Management Personnel (KMP) are required to disclose their Social Security numbers in order to obtain a personnel security clearance.

Energy Harbor Corp.

168 E. Market Street Akron, Ohio 44308 1-330-315-6824 84-3992199 See attached.

06/25/2020 12/16/2019

Delaware N/A N/A N/A N/A N/A N/A Darin M. Benyak Vice President, Nuclear Support and Regulatory Affairs

List ALL Owners, Officers, Directors, and Executive Personnel (OODEP's)

NRC FORM 405F (12-2018)

U. S. NUCLEAR REGULATORY COMMISSION Provide requested OODEP information in accordance with the following instructions. In addition, the OODEP listing must be certified as being accurate, current, and complete by an authorized official of the organization [i.e., a person authorized to represent and sign for the organization as officially recorded by the organization (that is, in the document which sets forth the terms and conditions for its operation and management--the bylaws, operating agreement, partnership agreement, etc.)] or any other employee, identified by name, of the organization, if designated in writing by such an authorized official as having been delegated authority to execute the FOCI repre. & certt. On behalf of the organization:

Owners. The requested information on owners and representatives or agents of stockholders is to be attached to the organization's OODEP listing:

1. For privately-owned organizations:

a. Provide the following information for each person (i.e., human being) who directly or indirectly owns or has beneficial ownership of 5 percent or more of any class of the organization's securities or who has directly or indirectly subscribed 5 percent or more of the organization's total capital commitment:

(1) If the beneficial owner holds a position as an OODEP in the organization and is identified on the OODEP listing, provide the individual's name with the class and number of shares of capital stock he/

she owns of the organization's securities or the capital commitment he/she has subscribed.

(2) If the beneficial owner does not hold a position as an OODEP in the organization and is not identified on the OODEP listing, provide the individual's name, address, and the class and number of shares of capital stock he/she owns of the organization's securities or the capital commitment he/she has subscribed. If known, information on the individual's citizenship should also be provided.

b. Provide the following information for each legal entity which directly or indirectly owns or has beneficial ownership of 5 percent or more of any class of the organization's securities or which has directly or indirectly subscribed 5 percent or more of the organization's total capital commitment:

The legal name (i.e., as specified in charter) with the address of its principal executive offices and the class and number of shares of capital stock the entity owns of the organization's securities or the capital commitment the entity has subscribed. In addition, if the entity is controlled by another organization, the country of ultimate legal residence must be provided.

c. Provide the name of any representative(s) or agent(s) of any owner (person or entity), if any, who hold positions, such as Board member (or similar type of governing body), officers, executive personnel, or general partners in your organization. Also identify the owner which the individual is representing.

2. For publicly-traded organizations:

a. Provide the most recent copies of any Schedules 13D and/or 13G received from any beneficial owners (foreign or domestic) who hold 5 percent or more of the organization's securities.

b. Provide the name of any representative(s) or agent(s) of any stockholder (person or entity), if any, who hold positions, such as Board member (or similar type of governing body), officers, executive personnel, or general partners in your organization. Also identity the stockholder which the individual is representing.

Officers: Identify and provide requested information (i.e., names, titles, etc.) for all of the organization's officers on the OODEP listing.

The definition of officers is: Those persons in positions established as officers as officially recorded by the organization (that is, in the document filed for the organization's existence and the document which sets forth the terms and conditions for its operation and management--the articles of incorporation and bylaws; articles of organization and operating agreement; certificate of limited or general partnership and the partnership agreement; etc.). However, excluded from this definition are: (a) assistant vice presidents who have no management responsibilities related to performance on classified contracts; (ii) assistant secretaries; and (iii) assistant treasurers.

Directors: Identify and provide requested information (i.e., names, titles, etc.) for all of the organization's directors on the OODEP listing, to include identification of the Chairman of the Board and any Vice Chairman. If the organization has no Chairman of the Board of Directors, identify the individual who performs those functions at board meetings.

The definition of directors is: Members of the board or similar governing body chosen to direct the affairs of a corporation or institution.

Executive Personnel: Identify and provide requested information (i.e., names, titles, etc.) for all of the organization's executive personnel on the OODEP listing.

The definition of executive personnel is: Those individuals who perform policy making functions for the organization, or any other person in charge of a principal business unit, division, or function.

Facility Security Officer: Identify and provide requested information (i.e., name, title, etc.) for the organization's Facility Security Officer.

The definition of a Facility Security Officer is: The individual at the facility assigned the responsibility of administering the requirements of the Safeguards and Security Program within the facility.

Spouse of a sole proprietor: For those sole proprietorships operating in community property states, identify and provide requested information (i.e., all information required on the OODEP listing) on a sole proprietor's spouse, if any. If there is no spouse, so state.

Vacant positions: If any OODEP position is vacant, so state and include estimated date vacancy will be filled.

INSTRUCTIONS:

Mail Completed NRC Form 405F to the following address: USNRC Office of Nuclear Security and Incident Response Mail Stop: O2 D15 11555 Rockville Pike Rockville, MD 20852-2738 10 CFR Part 95 NOTE: Consistent with Executive Order 12829 and the requirements in 10 CFR 95.18, individuals identified as Key Management Personnel (KMP) are required to disclose their Social Security numbers in order to obtain a personnel security clearance.

List ALL Owners, Officers, Directors, and Executive personnel (OODEPs)1, 2 Page _1___ of __2__

Companys Current Legal Name, Address, and Phone Number Other names used (e.g., doing business as):

Of companys Principal Executive Offices:

N/A Energy Harbor Corp. _

168 E. Market Street Tax Identification No. 84-3992199 Akron, OH 44308 Date Company was Incorporated: 12/16/2019 1-330-315-6824 State of Incorporation: Delaware (Must provide any name or address change of the Companys Principal executive office and date(s) of change during past 10 years on the Attachment page.)

Organization Status:

Corporation Sole Proprietorship Partnership:

General Limited Other: ____________________

Stock Ownership:

Privately-Owned Publicly-traded NAME First Name, Initial, Last Name POSITION TITLES IF OWNER,

% OF OWNERSHIP2 SSN CLEARANCE HELD AND/OR BEING OBTAINED AND ISSUING AGENCY CITIZENSHIP John C. Blickle Director N/A

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Douglas G. Johnston4 Director N/A

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Jennifer R. Kneale Director N/A

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Kevin T. Howell Director N/A

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John W. Pitesa4 Director N/A

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John (No Middle Name) Kiani Director, Executive Chairman N/A

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John W. Judge Director, President and Chief Executive Officer N/A

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Stephen E. Burnazian5 Director, Executive Vice President, Corporate Development, Corporate Secretary, and Chief Strategy Officer N/A

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Jay K. Bellingham Senior Vice President, Fossil N/A

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David L. Griffing Executive Vice President, Governmental Affairs N/A

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Jason S. Petrik Executive Vice President, Chief Financial Officer, Treasurer and Chief Risk Officer N/A

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David B. Hamilton Executive Vice President N/A

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Rickey C. Giannantonio Executive Vice President and General Counsel N/A

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N/A Facility Security Officer N/A N/A N/A N/A

1. The above information, i.e., name, titles, etc., must be provided for the following: (a) the proprietor of a sole proprietorship; (b) all individuals managing the business affairs of a corporation. In most cases, these individuals are identified in the Articles of Incorporation or By-Laws and include the Board of Directors, President, Secretary, and Treasurer; (c) the General Partner(s) of a Limited Partnership; and (d) all partners of a General partnership.

2. In addition, privately held entities must provide the above information, i.e., name, titles, etc., for all owners, and also provide the percentage of issued stock/shares held by each owner.

3. Information contained within the brackets [ ] is considered security-related or personal privacy information.

4. Individuals are appointees of Nuveen Asset Management, LLC. Mr. Johnston is an employee of Nuveen Asset Management, LLC.

5. Individual is an appointee of Avenue Capital Management II, L.P.

Redacted Owners, Officers, Directors, and Executive Personnel Form for Energy Harbor Nuclear Corp.

(Four pages follow)

List ALL Owners, Officers, Directors, and Executive Personnel (OODEP's)

NRC FORM 405F (12-2018)

U. S. NUCLEAR REGULATORY COMMISSION NRC FORM 405F (12-2018)

Company's Current Legal Name, Address, and Phone Number of Company's Principal Executive Offices:

Date Submitted:

Tax Identification No.

(Must provide any name or address change of the Company's principal executive office and date(s) of change during the past 10 years on the Attachment page).

Date Company was Incorporated:

State of Incorporation:

Organization Status:

Corporation Sole Proprietorship Partnership General Limited Other Stock Ownership:

Privately-Owned Publicly-Traded Subsidiary of:

NAME (First Name, Initial, Last Name)

POSITION TITLES IF OWNER,

% OF OWNERSHIP SSN CLEARANCE HELD AND/OR BEING OBTAINED AND ISSUING AGENCY CITIZENSHIP Other names used (e.g., doing business as):

Facility Security Officer The above information, i.e., name, titles, etc., must be provided for the following: (a) the proprietor of a sole proprietorship; (b) all individuals managing the business affairs of a corporation. In most cases, these individuals are identified in the Articles of Incorporation or By-Laws and include the Board of Directors, President, Secretary, and Treasurer; (c) the General Partner(s) of a Limited Partnership; and (d) all partners of a General Partnership. In addition, privately-held entities must provide the above information, i.e., name, titles, etc., for all owners, and also provide the percentage of issued stock/shares held by each owner.

List certified correct by: (Typed or Printed Name and Title)

SIGNATURE DATE OFFICIAL USE ONLY - SECURITY-RELATED INFORMATION 10 CFR Part 95 1

2 Estimated burden per response to comply with this collection request: 10 minutes. This collection is a voluntary means of complying with the requirements in 10 CFR 95.17. This notification is being made available to report changes to owners, officers, directors or executive personnel entities holding existing Facility Clearances under 10 CFR 95 or MD 12.2. Send comments regarding burden estimate to the Information Services Branch (O-1 F21), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.

Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0047), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

APPROVED BY OMB: 3150-0047 EXPIRES: 12/31/2018 NOTE: Consistent with Executive Order 12829 and the requirements in 10 CFR 95.18, individuals identified as Key Management Personnel (KMP) are required to disclose their Social Security numbers in order to obtain a personnel security clearance.

Energy Harbor Nuclear Corp.

168 E. Market Street Akron, Ohio 44308 1-330-315-6787 34-1881483 See attached.

06/25/2020 2/27/2020

Delaware N/A See attached.

Darin M. Benyak Vice President, Nuclear Support and Regulatory Affairs Energy Harbor Corp.