0001209191-23-038832.txt : 20230621 0001209191-23-038832.hdr.sgml : 20230621 20230621170704 ACCESSION NUMBER: 0001209191-23-038832 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230620 FILED AS OF DATE: 20230621 DATE AS OF CHANGE: 20230621 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Fagan James C. CENTRAL INDEX KEY: 0001981751 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39995 FILM NUMBER: 231030734 MAIL ADDRESS: STREET 1: 123 HARBOR DRIVE, UNIT 211 CITY: STAMFORD STATE: CT ZIP: 06902 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 doc4.xml FORM 4 SUBMISSION X0407 4 2023-06-20 0 0001822523 AFC Gamma, Inc. AFCG 0001981751 Fagan James C. 525 OKEECHOBEE BLVD. SUITE 1650 WEST PALM BEACH FL 33401 1 0 0 0 0 Common Stock 2023-06-20 4 A 0 1159 0.00 A 1159 D Common Stock 26520 I See footnote Represents restricted stock granted under the Issuer's Stock Incentive Plan and shall vest on the one-year anniversary of June 20, 2023, subject to early termination and adjustment as provided in the applicable restricted stock grant agreement. The shares are held directly by Civic Reserve LLC, a Wyoming limited liability company. Civic Reserve LLC is wholly owned by the Reporting Person and the Reporting Person's spouse. Gabriel Katz as attorney-in-fact for James Fagan 2023-06-21