SEC FORM 4/A SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
CIRCLE K STORES INC

(Last) (First) (Middle)
1130 WEST WARNER ROAD
BUILDING B

(Street)
TEMPE AZ 85284

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CrossAmerica Partners LP [ CAPL ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/10/2017
4. If Amendment, Date of Original Filed (Month/Day/Year)
03/05/2018
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Units 11/10/2017 J 126,491 A $26.0889 7,194,013(1) I See Footnote(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
CIRCLE K STORES INC

(Last) (First) (Middle)
1130 WEST WARNER ROAD
BUILDING B

(Street)
TEMPE AZ 85284

(City) (State) (Zip)
1. Name and Address of Reporting Person*
CST BRANDS, LLC

(Last) (First) (Middle)
19500 BULVERDE ROAD

(Street)
SAN ANTONIO TX 78259

(City) (State) (Zip)
1. Name and Address of Reporting Person*
CST USA INC.

(Last) (First) (Middle)
19500 BULVERDE ROAD

(Street)
SAN ANTONIO TX 78259

(City) (State) (Zip)
1. Name and Address of Reporting Person*
CST Services LLC

(Last) (First) (Middle)
ONE VALERO WAY
19500 BULVERDE ROAD

(Street)
SAN ANTONIO TX 78259

(City) (State) (Zip)
Explanation of Responses:
1. This Form 4/A is being filed to correct the original Form 4 filed on March 5, 2018 (the "Original Form 4"). The Original Form 4 incorrectly reported the amount of securities owned following the reported transaction as 7,070,010. This Form 4/A correctly reports the amount of securities owned following the reported transaction as 7,194,013.
2. Circle K Stores Inc., a Texas corporation indirectly owns 100% of CST Brands, LLC, a Delaware limited liability company, the owner of CST USA Inc., a Delaware corporation, which is the parent of CST Services LLC, a Delaware limited liability company. As a result, Circle K Stores Inc. is deemed the beneficial owner of CrossAmerica Partners LP, a Delaware limited partnership. CST Brands, LLC and CST USA Inc. are indirect beneficial owners of the common units held by CST Services LLC.
Remarks:
/s/ Giovanna Rueda, Authorized Representative of Circle K Stores Inc. 03/08/2018
/s/ Giovanna Rueda, Corporate Secretary of CST USA Inc. 03/08/2018
/s/ Giovanna Rueda, Corporate Secrertary of CST Services LLC 03/08/2018
/s/ Giovanna Rueda, Corporate Secretary CST Brands, LLC 03/08/2018
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.