1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Series A Convertible Preferred Stock, par value $.01/share
|
06/17/2004 |
Â
(5)
|
Common Stock, par value $.01 per share
|
49,488
(1)
|
$
30.31
|
D
|
Â
|
Series C Convertible Preferred Stock, par value $.01/share
|
03/07/2006 |
Â
(5)
|
Common Stock, par value $.01 per share
|
146,842
(2)
|
$
(3)
|
I
|
By Draupnir Capital, LLC
(4)
|
* |
If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) |
The 49,488 shares of Common Stock beneficially owned by Draupnir, LLC are in the form of 60,000 shares of Series A Convertible Preferred Stock, par value $.01 per share, which are convertible into 49,488 shares of Common Stock. |
(2) |
The 146,842 shares of Common Stock beneficially owned by Draupnir Capital, LLC, of which Draupnir, LLC is the sole member, are in the form of 80,000 Series C Convertible Preferred Stock, par value $.01 per share, which are convertible into 146,842 shares of Common Stock. |
(3) |
Each share of Series C Convertible Preferred Stock is convertible into a number of Common Stock of AMCON Distributing Company determined by dividing $25.00 by the Conversion Price, which is $13.62 and is subject to customary anti-dilution adjustments in the event of stock splits, stock dividends and certain other distributions on the Common Stock. |
(4) |
Draupnir, LLC is the sole member of Draupnir Capital, LLC. |
(5) |
N/A |