Amended Statement of Changes in Beneficial Ownership (4/a)
15 January 2022 - 01:20AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Tannenbaum Robyn |
2. Issuer Name and Ticker or Trading Symbol
AFC Gamma, Inc.
[
AFCG
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Managing Director |
(Last)
(First)
(Middle)
525 OKEECHOBEE BLVD., SUITE 1770 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/11/2022 |
(Street)
WEST PALM BEACH, FL 33401
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
1/13/2022 |
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (right to buy) | $20.18 | 1/11/2022 | | A | | 50000 | | 1/11/2022 (1) | 1/10/2029 | Common Stock | 50000 (2) | $0.00 | 50000 | D | |
Stock Option (right to buy) | $20.18 | 1/11/2022 | | A | | 500000 | | 1/11/2022 (1) | 1/10/2029 | Common Stock | 500000 (3) | $0.00 | 500000 | I | By spouse |
Explanation of Responses: |
(1) | The Stock Option is fully vested and became exercisable immediately upon grant. |
(2) | The original Form 4, filed on January 13, 2022, is being amended by this Form 4/A to correct an administrative error in reporting the number of shares underlying the Stock Option granted on January 11, 2022. |
(3) | 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. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Tannenbaum Robyn 525 OKEECHOBEE BLVD., SUITE 1770 WEST PALM BEACH, FL 33401 |
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| Managing Director |
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Signatures
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/s/Gabriel Katz as Attorney-in-Fact | | 1/14/2022 |
**Signature of Reporting Person | Date |
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