0000925421-21-000138.txt : 20210528 0000925421-21-000138.hdr.sgml : 20210528 20210528172846 ACCESSION NUMBER: 0000925421-21-000138 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210526 FILED AS OF DATE: 20210528 DATE AS OF CHANGE: 20210528 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jacoby Michael Z CENTRAL INDEX KEY: 0001794504 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09043 FILM NUMBER: 21981823 BUSINESS ADDRESS: BUSINESS PHONE: 3018281200 MAIL ADDRESS: STREET 1: 7250 WOODMONT AVENUE STREET 2: SUITE 350 CITY: BETHESDA STATE: MD ZIP: 20814 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Broad Street Realty, Inc. CENTRAL INDEX KEY: 0000764897 STANDARD INDUSTRIAL CLASSIFICATION: REAL ESTATE [6500] IRS NUMBER: 363361229 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 7250 WOODMONT AVE STREET 2: SUITE 350 CITY: BETHESDA STATE: MD ZIP: 20814 BUSINESS PHONE: 561-617-8050 MAIL ADDRESS: STREET 1: 7250 WOODMONT AVE STREET 2: SUITE 350 CITY: BETHESDA STATE: MD ZIP: 20814 FORMER COMPANY: FORMER CONFORMED NAME: MedAmerica Properties Inc. DATE OF NAME CHANGE: 20170619 FORMER COMPANY: FORMER CONFORMED NAME: Banyan Rail Services Inc. DATE OF NAME CHANGE: 20100106 FORMER COMPANY: FORMER CONFORMED NAME: BHIT INC DATE OF NAME CHANGE: 19990518 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2021-05-26 0000764897 Broad Street Realty, Inc. BRST 0001794504 Jacoby Michael Z C/O BROAD STREET REALTY, INC. 7250 WOODMONT AVE, SUITE 350 BETHESDA MD 20814 1 1 0 0 Chief Executive Officer Common Stock 2021-05-26 4 A 0 6813 A 2150492 D Received in exchange for membership interests in BSV Cromwell Parent LLC ("Cromwell"), pursuant to the previously disclosed Agreement and Plan of Merger (the "Cromwell Merger Agreement"), dated as of May 28, 2019, as amended on Nov. 27, 2019 and Dec. 27, 2019, by and among Cromwell, Broad Street Realty, Inc. (the "Issuer"), Broad Street Operating Partnership, LP and a subsidiary. Upon the closing of the transactions contemplated by the Cromwell Merger Agreement (the "Cromwell Merger"), the membership interests that were then outstanding were converted into the right to receive shares of the Issuer's common stock. As of the date immediately prior to the effective time of the Cromwell Merger, the last reported sales price of the Issuer's common stock on the OTC Pink Market was $1.25 per share. /s/ Andrew P. Campbell as attorney-in-fact for Michael Z. Jacoby 2021-05-28