0001493152-23-020290.txt : 20230606
0001493152-23-020290.hdr.sgml : 20230606
20230606161504
ACCESSION NUMBER: 0001493152-23-020290
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230602
FILED AS OF DATE: 20230606
DATE AS OF CHANGE: 20230606
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LEVINE JACK
CENTRAL INDEX KEY: 0001124852
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40809
FILM NUMBER: 23996250
MAIL ADDRESS:
STREET 1: C/O BLINK CHARGING CO.
STREET 2: 407 LINCOLN ROAD, SUITE 704
CITY: MIAMI BEACH
STATE: FL
ZIP: 33139
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: EzFill Holdings Inc
CENTRAL INDEX KEY: 0001817004
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-AUTO DEALERS & GASOLINE STATIONS [5500]
IRS NUMBER: 834260623
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2999 NE 191ST STREET
STREET 2: SUITE 500
CITY: AVENTURA
STATE: FL
ZIP: 33180
BUSINESS PHONE: 305-791-1169
MAIL ADDRESS:
STREET 1: 2999 NE 191ST STREET
STREET 2: SUITE 500
CITY: AVENTURA
STATE: FL
ZIP: 33180
4
1
ownership.xml
X0407
4
2023-06-02
0
0001817004
EzFill Holdings Inc
EZFL
0001124852
LEVINE JACK
C/O EZFILL HOLDINGS INC.
2999 NE 191ST STREET
AVENTURA
FL
33180
1
0
0
0
0
Common Stock
2023-06-02
4
A
0
58824
0
A
112262
D
The shares will fully vest in 12 months from the grant date. Should the Reporting Person leave the Issuer's board of directors prior to vesting, the Reporting Person will be awarded a grant on a pro rata basis based on the time spent as a member of the board of directors. The number of shares is based on $130,000 per the Issuer's director compensation agreement with the Reporting Person and the closing price $2.21 on June 2, 2023.
The Reporting Person holds 23,252 shares of Common Stock through an entity Cameo Life Sciences Investments, LLC. The number of shares reflects a one-for-eight reverse split effective on April 27, 2023.
Granted pursuant to the EzFill Holdings, Inc. 2023 Equity Incentive Plan.
/s/ Jack Levine
2023-06-06