-----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, SI4BzowyMKWbOzyhRRa4mnjyFNwvGZwvN8fYk7qIqBFbSpJ9wBtURWR2hgXXfK7P Uj6D8f8ZjfN6zELqZvC/3A== 0001014108-04-000120.txt : 20040621 0001014108-04-000120.hdr.sgml : 20040621 20040621212327 ACCESSION NUMBER: 0001014108-04-000120 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040617 FILED AS OF DATE: 20040621 ISSUER: 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 BUSINESS ADDRESS: STREET 1: 7405 IRVINGTON ROAD STREET 2: POST OFFICE BOX 641940 (68164-7940) CITY: OMAHA STATE: NE ZIP: 68122 BUSINESS PHONE: 4023313727 MAIL ADDRESS: STREET 1: 7405 IRVINGTON ROAD STREET 2: POST OFFICE BOX 641940 (68164-7940) CITY: OMAHA STATE: NE ZIP: 68122 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PETERSEN ALLEN D CENTRAL INDEX KEY: 0001007425 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15589 FILM NUMBER: 04873515 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 LINE ROAD CITY: BARRINGTON HILLS STATE: IL ZIP: 60010 4 1 primary_doc.xml PRIMARY DOCUMENT X0202 4 2004-06-17 0 0000928465 AMCON DISTRIBUTING CO DIT 0001007425 PETERSEN ALLEN D 122 WEST COUNTY LINE ROAD BARRINGTON HILLS IL 60010 1 0 0 0 Series A Convertible Preferred Stock 30.31 2004-06-17 4 P 0 60000 25 A 2004-06-17 Common Stock 49489 60000 I By Draupnir LLC Put Option (Right to Sell) 25 2004-06-17 4 S 0 60000 0 A 2004-06-17 2004-07-31 Series A Convertible Preferred Stock 60000 60000 I By Draupnir LLC Not applicable. The reporting person is a member and a managing director of the limited liability company that owns the reported securities. The reporting person disclaims beneficial ownership of the reported securities, except to the extent of his pecuniary interest therein. Allen D. Petersen 2004-06-21 -----END PRIVACY-ENHANCED MESSAGE-----