-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, PA5NUhaI/k6c2kT/COKoIvQWcmv4ZfwIOuFH5RL7rqtgAC4+2qUQNzcpS6zpVD7b KUrXrChGuQ1sUbjd2fJnig== 0000928465-01-500006.txt : 20010223 0000928465-01-500006.hdr.sgml : 20010223 ACCESSION NUMBER: 0000928465-01-500006 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20010214 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AMCON DISTRIBUTING CO CENTRAL INDEX KEY: 0000928465 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-GROCERIES & GENERAL LINE [5141] IRS NUMBER: 470702918 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: SEC FILE NUMBER: 005-49417 FILM NUMBER: 1539785 BUSINESS ADDRESS: STREET 1: 10228 L ST STREET 2: POST OFFICE BOX 241230 CITY: OMAHA STATE: NE ZIP: 68127 BUSINESS PHONE: 4023313727 MAIL ADDRESS: STREET 1: 10228 L STREET STREET 2: POST OFFICE 241230 CITY: OMAHA STATE: NE ZIP: 68127 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: PETERSEN ALLEN D CENTRAL INDEX KEY: 0001007425 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 2800 W HIGGINS ROAD STREET 2: SUITE 835 CITY: HOFFMAN ESTATES STATE: IL ZIP: 60195 BUSINESS PHONE: 8473103265 MAIL ADDRESS: STREET 1: 122 WEST COUNTY COUNTY LINE RD CITY: BARRINGTON HILLS STATE: IL ZIP: 60010 SC 13G/A 1 sch13g2000adp.txt UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. 4 )* ------- AMCON Distributing Company -------------------------------------------- (Name of Issuer) Common Stock, par value $.01 per share -------------------------------------------- (Title of Class of Securities) 02341Q106 ------------------ (CUSIP Number) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: / / Rule 13d-1(b) /x/ Rule 13d-1(c) / / Rule 13d-1(d) *The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior page. The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act. CUSIP NO. 02341Q106 --------- (1) Name of reporting person(s) Allen D. Petersen -------------------------------------------- I.R.S. identification no. of above persons (entities only) NOT REQUIRED ------------ (2) Check the appropriate box if a member of a (a) / / group (SEE INSTRUCTIONS) (b) / / (3) SEC USE ONLY (4) Citizenship or place of organization United States ---------------------------------- Number of shares beneficially owned by each reporting person with: (5) Sole voting power 32,140 ------------------------------------------------------ (6) Shared voting power 227,098 /1/ ---------------------------------------------------- (7) Sole dispositive power 32,140 ------------------------------------------------- (8) Shared dispositive power 227,098 /1/ ----------------------------------------------- (9) Aggregate amount beneficially owned by each reporting person 259,238 ---------- (10) Check if the aggregate amount in row (9) excludes certain shares / / (SEE INSTRUCTIONS) (11) Percent of class represented by amount in row (9) 9.4% ---------------------- (12) Type of reporting person (SEE INSTRUCTIONS) IN-Individual ---------------------------- /1/ Represents shares held by the Lifeboat Foundation, of which the undersigned is a director. The undersigned hereby expressly disclaims beneficial ownership of 227,098 shares of common stock of AMCON Distributing Company issued in the name of The Lifeboat Foundation and the filing of this Schedule 13G with respect thereto shall not be construed as an admission that the undersigned is a beneficial owner of any such securities for purposes of Sections 13(d) or 13(g) of the Securities Act of 1934. ITEM 1(a). NAME OF ISSUER: AMCON Distributing Company ITEM 1(b). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES: 10228 "L" Street Omaha, Nebraska 68127 ITEM 2 (a). NAME OF PERSON FILING: Allen D. Petersen ITEM 2 (b). ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE: 2800 Higgins Road, Suite 835 Hoffman Estates, IL 60195 ITEM 2 (c). CITIZENSHIP: United States ITEM 2 (d). TITLE OF CLASS OF SECURITIES: Common Stock, par value $.01 per share ITEM 2. (e). CUSIP No.: 02341Q106 ITEM 3. STATEMENTS FILED PURSUANT TO RULES 13D-1(B) OR 13D-2(B) (C): Not applicable ITEM 4. OWNERSHIP: (a) Amount Beneficially Owned: 259,238 (b) Percent of Class: 9.4% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote 32,140 --------- (ii) shared power to vote or to direct the vote 227,098 /1/ -------- (iii) sole power to dispose or to direct the disposition of 32,140 -------- (iv) shared power to dispose or to direct the disposition of 227,098 /1/ -------- /1/ Represents shares held by the Lifeboat Foundation, of which the undersigned is a director. The undersigned hereby expressly disclaims beneficial ownership of 227,098 shares of common stock of AMCON Distributing Company issued in the name of The Lifeboat Foundation and the filing of this Schedule 13G with respect thereto shall not be construed as an admission that the undersigned is a beneficial owner of any such securities for purposes of Sections 13(d) or 13(g) of the Securities Act of 1934. INSTRUCTION. For computations regarding securities which represent a right to acquire an underlying security see Rule 13d-3(d)(1). ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS: Not Applicable ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON: The Lifeboat Foundation has the right to receive all dividends and all proceeds from the sale of such securities. ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY: Not Applicable ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP: Not Applicable ITEM 9. NOTICE OF DISSOLUTION OF GROUP: Not Applicable ITEM 10. CERTIFICATION: By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect. SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. Date: February 14, 2001 /s/ Allen D. Petersen ---------------------------- ---------------------------------------- (Signature) Allen D. Petersen ---------------------------------------- (Name/Title) The original statement shall be signed by each person on whose behalf the statement is filed or his authorized representative. If the statement is signed on behalf of a person by his authorized representative (other than an executive officer or general partner of the filing person), evidence of the representative's authority to sign on behalf of such person shall be filed with the statement, provided, however, that a power of attorney for this purpose which is already on file with the Commission may be incorporated by reference. The name and any title of each person who signs the statement shall be typed or printed beneath his signature. -----END PRIVACY-ENHANCED MESSAGE-----