0001493152-22-003339.txt : 20220207 0001493152-22-003339.hdr.sgml : 20220207 20220207110838 ACCESSION NUMBER: 0001493152-22-003339 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220204 FILED AS OF DATE: 20220207 DATE AS OF CHANGE: 20220207 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HANREHAN Cheryl Edith CENTRAL INDEX KEY: 0001876821 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40809 FILM NUMBER: 22596126 MAIL ADDRESS: STREET 1: 2125 BISCAYNE BLVD, STREET 2: STE. 309 CITY: MIAMI STATE: FL ZIP: 33137 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: 2125 BISCAYNE BLVD STREET 2: #309 CITY: MIAMI STATE: FL ZIP: 33137 BUSINESS PHONE: 305-791-1169 MAIL ADDRESS: STREET 1: 2125 BISCAYNE BLVD STREET 2: #309 CITY: MIAMI STATE: FL ZIP: 33137 4 1 ownership.xml X0306 4 2022-02-04 0 0001817004 EzFill Holdings Inc EZFL 0001876821 HANREHAN Cheryl Edith C/O EZFILL HOLDINGS, INC. 2125 BISCAYNE BLVD, #309 MIAMI FL 33137 1 0 0 0 Common Stock 2022-02-04 4 A 0 22321 A 48894 D Options 1.26 2022-02-04 4 A 0 125951 0 A 2022-02-04 2030-02-04 Common Stock 125951 125951 D Granted pursuant to a Separation Agreement between the Issuer and the Reporting Person. The Reporting Person was granted $28,125 of restricted Common Stock pursuant to the EzFill Holdings, Inc. 2020 Incentive Compensation Plan with the common stock valued at the closing price on January 20, 2022 ($ 1.26 per share). The shares vest immediately. The Options were granted pursuant to the EzFill 2020 Incentive Compensation Plan and vest immediately. /s/ Cheryl Hanrehan 2022-02-07