0001104659-17-005814.txt : 20170201
0001104659-17-005814.hdr.sgml : 20170201
20170201162901
ACCESSION NUMBER: 0001104659-17-005814
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170131
FILED AS OF DATE: 20170201
DATE AS OF CHANGE: 20170201
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Affinity Gaming
CENTRAL INDEX KEY: 0001499268
STANDARD INDUSTRIAL CLASSIFICATION: HOTELS & MOTELS [7011]
IRS NUMBER: 020815199
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 3755 BREAKTHROUGH WAY
STREET 2: SUITE 300
CITY: LAS VEGAS
STATE: NV
ZIP: 89135
BUSINESS PHONE: (702) 341-2400
MAIL ADDRESS:
STREET 1: 3755 BREAKTHROUGH WAY
STREET 2: SUITE 300
CITY: LAS VEGAS
STATE: NV
ZIP: 89135
FORMER COMPANY:
FORMER CONFORMED NAME: Affinity Gaming, LLC
DATE OF NAME CHANGE: 20110630
FORMER COMPANY:
FORMER CONFORMED NAME: Herbst Gaming, LLC
DATE OF NAME CHANGE: 20100816
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tanjeloff Eric
CENTRAL INDEX KEY: 0001577384
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-54085
FILM NUMBER: 17565268
MAIL ADDRESS:
STREET 1: C/O AFFINITY GAMING
STREET 2: 3755 BREAKTHROUGH WAY, SUITE 300
CITY: LAS VEGAS
STATE: NV
ZIP: 89135
4
1
a4.xml
4
X0306
4
2017-01-31
1
0001499268
Affinity Gaming
NONE
0001577384
Tanjeloff Eric
C/O AFFINITY GAMING
3755 BREAKTHROUGH WAY, SUITE 300
LAS VEGAS
NV
89135
1
0
0
0
Common Stock
2017-01-31
4
D
0
28061
17.35
D
0
D
Pursuant to the Agreement and Plan of Merger, dated as of August 22, 2016, among Z Capital Affinity Owner, LLC ("Parent"), Affinity Merger Sub, Inc. and Affinity Gaming (the "Merger Agreement"), at the effective time of the merger of Affinity Merger Sub, Inc. with and into Affinity Gaming (the "Merger") each share of Affinity Gaming common stock converted into the right to receive $17.35 in cash. The Merger is more completely described in the Company's Definitive Proxy Statement filed with the SEC on November 14, 2016.
Includes shares of restricted stock. Pursuant to the Merger Agreement, each restricted stock award outstanding immediately prior to the effective time of the Merger was converted into the right to receive an amount in cash equal to the product of (i) $17.35 and (ii) the number of shares of Affinity Gaming common stock subject to such award.
/s/ Marc H. Rubinstein, as Attorney-in-Fact for Eric Tanjeloff
2017-02-01