0001493152-23-041701.txt : 20231116 0001493152-23-041701.hdr.sgml : 20231116 20231116165852 ACCESSION NUMBER: 0001493152-23-041701 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230804 FILED AS OF DATE: 20231116 DATE AS OF CHANGE: 20231116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Leibler Jack CENTRAL INDEX KEY: 0001999554 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40809 FILM NUMBER: 231415344 MAIL ADDRESS: STREET 1: 68-41 JUNO STREET CITY: FOREST HILLS STATE: NY ZIP: 11375 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: EzFill Holdings Inc CENTRAL INDEX KEY: 0001817004 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-AUTO DEALERS & GASOLINE STATIONS [5500] IRS NUMBER: 834260623 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 67 NW 183RD ST CITY: MIAMI STATE: FL ZIP: 33169 BUSINESS PHONE: 305-791-1169 MAIL ADDRESS: STREET 1: 67 NW 183RD ST CITY: MIAMI STATE: FL ZIP: 33169 4 1 ownership.xml X0508 4 2023-08-04 0 0001817004 EzFill Holdings Inc EZFL 0001999554 Leibler Jack C/O EZFILL HOLDINGS INC., 67 NW 183RD STREET MIAMI FL 33169 1 0 0 0 0 Restricted Common Stock 2023-08-04 4 A 0 54714 1.98 A 54714 D The shares will fully vest in 12 months from the grant date. Should the Reporting Person leave the Issuer's board of directors prior to vesting, the Reporting Person will be awarded a grant on a pro rata basis based on the time spent as a member of the board of directors. The number of shares is based on annual director compensation of $130,000 per the Issuer's director compensation agreement with the Reporting Person and the closing price $1.98 on August 4, 2023. Granted pursuant to the EzFill Holdings, Inc. 2023 Equity Incentive Plan. The number of shares reflects a one-for-eight reverse split effective on April 27, 2023. /s/ Jack Leibler 2023-11-16