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