0000899243-23-011290.txt : 20230414 0000899243-23-011290.hdr.sgml : 20230414 20230414174645 ACCESSION NUMBER: 0000899243-23-011290 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221231 FILED AS OF DATE: 20230414 DATE AS OF CHANGE: 20230414 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HEYER ANDREW R CENTRAL INDEX KEY: 0001259062 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39828 FILM NUMBER: 23822249 MAIL ADDRESS: STREET 1: 501 MADISON AVENUE, FLOOR 5 CITY: NEW YORK STATE: NY ZIP: 10019 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ARKO Corp. CENTRAL INDEX KEY: 0001823794 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-CONVENIENCE STORES [5412] IRS NUMBER: 852784337 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 8565 MAGELLAN PKWY STREET 2: SUITE 400 CITY: RICHMOND STATE: VA ZIP: 23227 BUSINESS PHONE: 804-730-1568 MAIL ADDRESS: STREET 1: 8565 MAGELLAN PKWY STREET 2: SUITE 400 CITY: RICHMOND STATE: VA ZIP: 23227 5 1 doc5.xml FORM 5 SUBMISSION X0407 5 2022-12-31 0 0 0 0001823794 ARKO Corp. ARKO 0001259062 HEYER ANDREW R 501 MADISON AVENUE, FLOOR 5 NEW YORK NY 10019 1 0 0 0 0 Common Stock 2022-08-19 5 G 0 179649 0.00 D 605331 D Common Stock 2022-08-19 5 G 0 179649 0.00 A 179649 I By Heyer Investment Management, LLC Private Placement Warrants 11.50 2022-08-19 5 G 0 337873 0.00 D 2020-12-22 2025-12-22 Common Stock 337873 0 D Private Placement Warrants 11.50 2022-08-19 5 G 0 337873 0.00 A 2020-12-22 2025-12-22 Common Stock 337873 337873 I By Heyer Investment Management, LLC On August 19, 2022, upon the termination of the Andrew R. Heyer 2019 Grantor Retained Annuity Trust (the "Retained Annuity Trust"), 179,649 shares of ARKO Corp. common stock were transferred to Heyer Investment Management, LLC, of which the reporting person is the managing member, and 56,500 shares of ARKO Corp. common stock were transferred directly to the reporting person. The latter transfer represented a change in the reporting person's form of ownership and, therefore, was exempt from Section 16 pursuant to Rule 16a-13 under the Securities Exchange Act of 1934, as amended. On August 19, 2022, upon the termination of the Retained Annuity Trust, 337,873 private placement warrants to purchase shares of ARKO Corp. common stock were transferred to Heyer Investment Management, LLC, of which the reporting person is the managing member. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. /s/ Andrew R. Heyer 2023-04-14