0001437749-15-014770.txt : 20150804 0001437749-15-014770.hdr.sgml : 20150804 20150804210357 ACCESSION NUMBER: 0001437749-15-014770 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150731 FILED AS OF DATE: 20150804 DATE AS OF CHANGE: 20150804 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: GOLDEN ENTERTAINMENT, INC. CENTRAL INDEX KEY: 0001071255 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS AMUSEMENT & RECREATION [7990] IRS NUMBER: 411913991 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 130 CHESHIERE LANE CITY: MINNETONKA STATE: MN ZIP: 55305 BUSINESS PHONE: 6124499092 MAIL ADDRESS: STREET 1: 6595 S JONES BLVD CITY: LAS VEGAS STATE: NV ZIP: 89118 FORMER COMPANY: FORMER CONFORMED NAME: LAKES ENTERTAINMENT INC DATE OF NAME CHANGE: 20020806 FORMER COMPANY: FORMER CONFORMED NAME: LAKES GAMING INC DATE OF NAME CHANGE: 19980929 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SARTINI DELISE F CENTRAL INDEX KEY: 0000939978 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24993 FILM NUMBER: 151027235 MAIL ADDRESS: STREET 1: 2411 WEST SAHARA AVENUE CITY: LAS VEGAS STATE: NV ZIP: 89102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Blake L. Sartini & Delise F. Sartini Family Trust CENTRAL INDEX KEY: 0001649906 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24993 FILM NUMBER: 151027236 BUSINESS ADDRESS: STREET 1: 6595 S JONES BLVD CITY: LAS VEGAS STATE: NV ZIP: 89118 BUSINESS PHONE: 7024954377 MAIL ADDRESS: STREET 1: 6595 S JONES BLVD CITY: LAS VEGAS STATE: NV ZIP: 89118 4 1 rdgdoc.xml FORM 4 X0306 4 2015-07-31 0001071255 GOLDEN ENTERTAINMENT, INC. GDEN 0001649906 Blake L. Sartini & Delise F. Sartini Family Trust 6595 S. JONES BLVD. LAS VEGAS NV 89118 1 1 0000939978 SARTINI DELISE F 6595 S. JONES BLVD. LAS VEGAS NV 89118 1 1 Common Stock 2015-07-31 4 A 0 7772736 A 7772736 D The Blake L. Sartini and Delise F. Sartini Family Trust acquired 7,772,736 shares of issuer common stock pursuant to that certain Agreement and Plan of Merger, dated as of January 25, 2015, by and among Lakes Entertainment, Inc., LG Acquisition Corporation, Sartini Gaming, Inc., and the Blake L. Sartini and Delise F. Sartini Family Trust, as amended (the "Merger Agreement"), in exchange for 100% of the outstanding common stock of Sartini Gaming, Inc., in connection with the merger of LG Acquisition Corporation with and into Sartini Gaming, Inc. Blake L. Sartini and Delise F. Sartini are co-trustees and co-beneficiaries of The Blake L. Sartini and Delise F. Sartini Family Trust. Of the 7,772,736 shares, 388,637 shares are being held in escrow as security for the post-closing adjustment in accordance with the Merger Agreement, and 777,274 shares are being held in escrow as security for claims for indemnifiable losses in accordance with the Merger Agreement. These shares are owned directly by The Blake L. Sartini and Delise F. Sartini Family Trust, and indirectly by Delise F. Sartini, as co-trustee of the trust. Directors by Deputization /s/ Blake Sartini, Co-Trustee 2015-08-04 /s/ Delise Sartini, Co-Trustee 2015-08-04 /s/ Delise F. Sartini 2015-08-04