-----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, VlqkF2kOQ+4Gh8nQ4y11Z9NsuqF7+TyL6Ut/dykhfhbRrnearUpk9We87Q68a0ez B03jIf9kl3JSpP6fKiEP6g== 0001014108-04-000141.txt : 20040720 0001014108-04-000141.hdr.sgml : 20040720 20040720171933 ACCESSION NUMBER: 0001014108-04-000141 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20040720 GROUP MEMBERS: ALLEN D. PETERSEN 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 SEC ACT: 1934 Act SEC FILE NUMBER: 005-49417 FILM NUMBER: 04922694 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 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: PETERSEN ALLEN D CENTRAL INDEX KEY: 0001007425 FILING VALUES: FORM TYPE: SC 13G 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 SC 13G 1 adc-sch13gpetersen_693511v2.txt SCHEDULE 13G SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 AMCON Distributing Company. ---------------------------------------------------------- (Name of Issuer) Common Stock - $.01 par value ---------------------------------------------------------- (Title of Class of Securities) 02341Q106 ------------ (CUSIP Number) June 17, 2004 ------------------------- (Date of Event which Requires Filing of this Statement) 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 cover page. The information required in 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 (however, see the Notes). - ------------------------------ CUSIP No. 02341Q106 13G -------------------- - ------------------------------ - ------------------------------------------------------------------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (entities only) Allen D. Petersen - ------------------------------------------------------------------------------ 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (see instructions) (a) [ ] (b) [ ] - ------------------------------------------------------------------------------ 3 SEC USE ONLY - ------------------------------------------------------------------------------ 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States - ------------------------------------------------------------------------------ 5 SOLE VOTING POWER 54,846 NUMBER OF SHARES 6 SHARED VOTING POWER 37,850 BENEFICIALLY OWNED BY EACH 7 SOLE DISPOSITIVE POWER 54,846 REPORTING PERSON WITH 8 SHARED DISPOSITIVE POWER 37,850 - ------------------------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 92,696 - ------------------------------------------------------------------------------ 10 CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (see instructions) [ ] - ------------------------------------------------------------------------------ 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9 16.1% - ------------------------------------------------------------------------------ 12 TYPE OF REPORTING PERSON IN - ------------------------------------------------------------------------------ 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: 500 North Dearborn, 2nd Floor Chicago, Illinois 60610 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 Number: 02341Q106 ITEM 3: If this statement is filed pursuant to ss.ss. 240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a: Not applicable ITEM 4: Ownership (a) Amount beneficially owned: 92,696 (b) Percent of class: 16.1% (c) Number of shares of which such person has (i) sole power to vote or to direct the vote: 54,846 (ii) shared power to vote or to direct the vote: 37,850 (iii) sole power to dispose or to direct the disposition of: 54,846 (iv) shared power to dispose or to direct the disposition of: 37,850 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. Allen Petersen is a member and managing director of Draupnir LLC, which owns 60,000 shares of Series A Convertible Preferred Stock of AMCON Distributing Company. These shares of Preferred Stock are convertible into 49,489 shares of AMCON's Common Stock, which is included in the number of shares of Common Stock that Mr. Petersen has sole power to direct the voting or disposition of such shares set forth in Item 4 above. Mr. Petersen shares power to direct the voting or disposition of 37,850 shares of AMCON Common Stock through his ownership interest in Lifeboat Foundation. ITEM 7: Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company or Control Person. Not applicable. ITEM 8: Identification and Classification of Members of the Group. Not applicable. ITEM 9: Notice of Dissolution of Group. Not applicable. [The remainder of this page intentionally has been left blank] 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. July 20, 2004 By: /s/ Allen D. Petersen --------------------- Allen D. Petersen -----END PRIVACY-ENHANCED MESSAGE-----