-----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, I3AHoXCgA0O/3wY5q5YC9kakekdy5wjNSQeBMRX3iuF52wOOwdF+ntbmEy5Gj46E Rzo9YI6TKqvJeF8v+7NOTg== 0000928465-01-500058.txt : 20020412 0000928465-01-500058.hdr.sgml : 20020412 ACCESSION NUMBER: 0000928465-01-500058 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20011130 FILED AS OF DATE: 20011210 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15589 FILM NUMBER: 1810500 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 COMPANY DATA: COMPANY CONFORMED NAME: EVANS KATHLEEN M CENTRAL INDEX KEY: 0001007423 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 15701 NORTH 47TH ST CITY: OMAHA STATE: NE ZIP: 68152 BUSINESS PHONE: 4024550308 MAIL ADDRESS: STREET 1: 15701 NORTH 47TH ST CITY: OMAHA STATE: NE ZIP: 68152 4 1 form4kme1101.txt FORM 4 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 [_] Check this box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) - ---------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Evans, Kathleen M. - ---------------------------------------------------------------------------- (Last) (First) (Middle) 1750 County Road #49 - ---------------------------------------------------------------------------- (Street) Omaha, NE 68152 - ---------------------------------------------------------------------------- (City) (State) (Zip) ============================================================================ 2. Issuer Name and Ticker or Trading Symbol AMCON Distributing Company "DIT" - ---------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ###-##-#### - ---------------------------------------------------------------------------- 4. Statement for Month/Year 11/2001 - ---------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) ============================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] 10% Owner [X] Officer (give title below) [_] Other (specify below) President ---------------------- - ---------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check applicable line) [_] Form filed by one Reporting Person [_] Form filed by more than one Reporting Person - ---------------------------------------------------------------------------- ============================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ============================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, Par Value $0.01 per share 11/23/2001 P 5,601 A $4.094 5,601 I /1/ - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, Par Value $0.01 per share 146,536 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v).
(Over) (SEC 1474 (3-00) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Options - Commom Stock $4.00 11/23/01 P 5,292 11/23/01 3/1/02 Common 5,292 n/a 5,292 I /1/ Stock - ------------------------------------------------------------------------------------------------------------------------------------ Options - Common Stock Common Stock 38,500 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: /1/ Represents Mr. Howard's ownership percentage in shares and options purchased and held by AMCON Corporation, of which Mr. Howard is a shareholder, director and officer. Kathleen M. Evans December 10, 2001 - --------------------------------------------- ----------------------- **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Page 2 -----END PRIVACY-ENHANCED MESSAGE-----