0001140361-21-010093.txt : 20210325 0001140361-21-010093.hdr.sgml : 20210325 20210325213652 ACCESSION NUMBER: 0001140361-21-010093 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210323 FILED AS OF DATE: 20210325 DATE AS OF CHANGE: 20210325 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TANNENBAUM LEONARD M CENTRAL INDEX KEY: 0001200461 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39995 FILM NUMBER: 21774383 MAIL ADDRESS: STREET 1: 525 OKEECHOBEE BLVD., SUITE 1770 CITY: WEST PALM BEACH STATE: FL ZIP: 33401 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AFC Gamma, Inc. CENTRAL INDEX KEY: 0001822523 STANDARD INDUSTRIAL CLASSIFICATION: REAL ESTATE [6500] IRS NUMBER: 851807125 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 525 OKEECHOBEE BLVD., SUITE 1770 CITY: WEST PALM BEACH STATE: FL ZIP: 33401 BUSINESS PHONE: 561.510.2390 MAIL ADDRESS: STREET 1: 525 OKEECHOBEE BLVD., SUITE 1770 CITY: WEST PALM BEACH STATE: FL ZIP: 33401 4 1 form4.xml FORM 4 X0306 4 2021-03-23 0001822523 AFC Gamma, Inc. AFCG 0001200461 TANNENBAUM LEONARD M 525 OKEECHOBEE BLVD., SUITE 1770 WEST PALM BEACH FL 33401 true true true Chief Executive Officer Common Stock 2021-03-23 4 P 0 1000 19 A 1000 I by spouse Common Stock 3342500 D Stock Option (right to buy) 19 2021-03-23 4 A 0 630000 0 A 2028-03-23 Common Stock 630000 630000 D Stock Option (right to buy) 19 2021-03-23 4 A 0 14000 0 A 2028-03-23 Common Stock 14000 14000 I by spouse The shares were purchased by the spouse of the Reporting Person in the Issuer's directed share program at the initial public offering price. The Reporting Person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. The shares subject to this option fully vested and became exercisable upon the consummation of the Issuer's initial public offering. /s/ Regina Braman, Attorney-in-Fact for Leonard Tannenbaum 2021-03-25