0001062993-22-001043.txt : 20220113 0001062993-22-001043.hdr.sgml : 20220113 20220113214741 ACCESSION NUMBER: 0001062993-22-001043 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211231 FILED AS OF DATE: 20220113 DATE AS OF CHANGE: 20220113 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Spiritos Samuel M CENTRAL INDEX KEY: 0001794510 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09043 FILM NUMBER: 22530338 BUSINESS ADDRESS: BUSINESS PHONE: 3018281200 MAIL ADDRESS: STREET 1: 7250 WOODMONT AVENUE STREET 2: SUITE 350 CITY: BETHESDA STATE: MD ZIP: 20814 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Broad Street Realty, Inc. CENTRAL INDEX KEY: 0000764897 STANDARD INDUSTRIAL CLASSIFICATION: REAL ESTATE [6500] IRS NUMBER: 363361229 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 7250 WOODMONT AVE STREET 2: SUITE 350 CITY: BETHESDA STATE: MD ZIP: 20814 BUSINESS PHONE: 561-617-8050 MAIL ADDRESS: STREET 1: 7250 WOODMONT AVE STREET 2: SUITE 350 CITY: BETHESDA STATE: MD ZIP: 20814 FORMER COMPANY: FORMER CONFORMED NAME: MedAmerica Properties Inc. DATE OF NAME CHANGE: 20170619 FORMER COMPANY: FORMER CONFORMED NAME: Banyan Rail Services Inc. DATE OF NAME CHANGE: 20100106 FORMER COMPANY: FORMER CONFORMED NAME: BHIT INC DATE OF NAME CHANGE: 19990518 5 1 form5.xml ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP X0306 5 2021-12-31 0 1 0000764897 Broad Street Realty, Inc. BRST 0001794510 Spiritos Samuel M C/O BROAD STREET REALTY, INC. 7250 WOODMONT AVE, SUITE 350 BETHESDA MD 20814 1 0 0 0 Common Stock 2021-12-23 4 P 0 3000 2.45 A 51701 D Common Stock 13827 I By SR BSV Spotswood LLC The reporting person is the manager of a limited liability company that owns the reported securities. The reporting person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. /s/ Andrew P. Campbell as attorney-in-fact for Samuel M. Spiritos 2022-01-13