FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/12/2004 |
3. Issuer Name and Ticker or Trading Symbol
EMPIRE RESORTS INC [ NYNY ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock, $.01 par value per share | 2,263,558(1) | I | By Americas Tower Partners |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. These shares of common stock of the Issuer (the "Shares" ) represent a portion of the 6,599,294 Shares issued to Americas Tower Partners ("ATP") in consideration for ATP's holdings in Monticello Raceway Development Company, LLC, Monticello Casino Management, LLC, Mohawk Management, LLC and Monticello Raceway Management, Inc. pursuant to that certain Amended and Restated Securities Contribution Agreement, dated as of December 12, 2003 (the "Contribution Agreement"). These Shares represent the JB Trust's holdings of a 49% economic interest, with no voting rights, in ATP, representing an indirect beneficial ownership interest in 2,263,558 of the Shares issued to ATP pursuant to the Contribution Agreement. The aggregate market value of the JB Trust's interest in ATP's holdings (referenced above), based on the market price of the consideration received at closing ($9.10 per share), was $20,598,377.80. |
Remarks: |
By: JB Trust, By: /s/ Helen Bernstein, Sole Trustee | 01/13/2004 | |
** 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 5 (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. |