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The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter
disclosures provided in a prior cover page.
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CUSIP No. 00109K105
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Page 2 of 6 Pages |
1
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NAMES OF REPORTING PERSONS
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Leonard M. Tannenbaum
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
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(a)
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☐
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(b)
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☐
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3
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SEC USE ONLY
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4
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SOURCE OF FUNDS (SEE INSTRUCTIONS)
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PF; OO (See Item 3)
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5
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CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEM 2(D) OR 2(E)
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☐
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION
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United States
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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7
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SOLE VOTING POWER
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4,749,458
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8
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SHARED VOTING POWER
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0 |
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9
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SOLE DISPOSITIVE POWER
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4,749,458
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10
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SHARED DISPOSITIVE POWER
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0 |
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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4,749,458
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12
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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☐
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
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32.2% (1) |
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14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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IN |
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CUSIP No. 00109K105
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Page 3 of 6 Pages |
Item 1. |
Security and Issuer.
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Item 2. |
Identity and Background.
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Item 3. |
Source and Amount of Funds or Other Consideration.
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Item 4. |
Purpose of Transaction.
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Item 5. |
Interest in Securities of the Issuer.
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CUSIP No. 00109K105
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Page 4 of 6 Pages |
Item 6. |
Contracts, Arrangements, Understandings or Relationships With Respect to Securities of the Issuer.
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CUSIP No. 00109K105
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Page 5 of 6 Pages |
Item 7. |
Materials to be Filed as Exhibits.
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Exhibit No.
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Description
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Exhibit 1:
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Articles of Amendment and Restatement of AFC Gamma, Inc. (incorporated by reference to Exhibit 3.2 to the Issuer’s Registration Statement on Form S-11, as amended (File No. 333-251762))
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Exhibit 2:
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Form of Registration Rights Agreement, by and among AFC Gamma, Inc. and the holders thereto (incorporated by reference to Exhibit 10.4 to the Issuer’s Registration Statement on Form S-11, as amended (File No. 333-251762))
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CUSIP No. 00109K105
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Page 6 of 6 Pages |
Date:
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April 2, 2021
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LEONARD M. TANNENBAUM
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/s/ Leonard M. Tannenbaum
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