New Jersey Administrative Code › Title 13 - LAW AND PUBLIC SAFETY › Chapter 69A - APPLICATIONS › Subchapter 5 - FORMS › Section 13:69A-5.6D - New Jersey Supplemental Form to the Multi-Jurisdictional Business Form-Casino Company; Casino Holding and Intermediary Company

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A New Jersey Supplemental Form to the
				Multi-Jurisdictional Business Form shall be in a format prescribed by the
				Division and may require the applicant to provide the following information:
1. The home and mobile phone numbers of a
				primary and alternate person to be contacted in reference to the
				application;
2. The terms,
				conditions, rights, and privileges of all classes of voting, nonvoting, and
				security or other ownership interest issued, and the number of outstanding
				shares, and an explanation if the right of holders of any class of security may
				be modified otherwise than by a vote of a majority or more of the outstanding
				shares so affected, voting as a class;
3. A description of the nature, type, terms,
				covenants, conditions, and priorities of all outstanding bonds, loans,
				mortgages, notes, debentures, or other forms of indebtedness issued or
				executed, including loans made by shareholders, or to be issued or executed by
				the business entity, which mature more than one year from the date of issuance
				or which, by their terms, are renewable for a period of more than one year from
				the date of issuance;
4. The names,
				positions, and amount of compensation for individuals being compensated between
				$ 150,000 and $ 250,000;
5. The
				bank name, account number, branch, and authorized signatories for all bank or
				other financial institution accounts, whether foreign or domestic, held by the
				business entity, any nominee of the business entity, or entity under the
				indirect control of the business entity for the last 10 years;
6. The name and address of each company in
				which the business entity holds securities or other ownership interest, type of
				securities or other ownership interest held, purchase price per share or
				interest, number of shares held, and percentage of ownership, if more than five
				percent;
7. The name and address,
				date of birth, type and debt class of debt instrument held, original amount of
				debt, and current balance of debt for each person or entity holding any
				outstanding bonds, mortgages, trust deeds, notes, debentures, or other forms of
				indebtedness, regardless of amount, executed or issued by the business entity,
				that mature more than one year from the date of issuance or which, by their
				terms, are renewable for a period of more than one year from the date of
				issuance;
8. For bonus, profit
				sharing, pension, retirement, deferred compensation, and similar plans operated
				by the applicant, provide material features and methods of financing the plan,
				classes of participants, approximate number of persons in each class, and
				amounts distributed to each class of persons during the last fiscal
				year;
9. The name of the person
				appointed, the court, and the reason for appointment of any administrator,
				receiver, manager, liquidator, or provisional liquidator appointed to the
				applicant or its related companies due to insolvency;
10. Copies of the following documents:
i. Annual reports of the business entity that
				were submitted to shareholders or other persons during the last five years if
				not already submitted in response to the Multi-Jurisdictional Business
				Form;
ii. The last quarterly,
				unaudited financial statements prepared by or for the business entity;
				and
iii. Any current report
				prepared due to the occurrence of the following events: change in control of
				the business entity, acquisition or disposition of assets, bankruptcy or
				receivership proceedings, changes in the business entity's certifying
				accountant, or other material events;
11. All addresses from which the business
				entity is or will be conducting any business, as part of an agreement with a
				casino hotel;
12. The name, last
				known address, occupation(s) and date of birth of each incorporator or founding
				person of the business entity;
13.
				The annual compensation of each officer, director, or trustee of the business
				entity and form of compensation for the last calendar year and the amount to be
				received during the subsequent calendar year;
14. The name, home address, and date of birth
				of each shareholder, the class held, number of shares held, and the percentage
				of outstanding nonvoting securities or other ownership interest held;
15. A description of the nature, type, terms,
				conditions, and covenants of any other outstanding evidence of indebtedness or
				security device utilized by the business entity;
16. The name, address, and date of formation
				or birth of each person holding the debt or security devices in (a)15 above,
				the type of debt instrument held, the original debt amount, and current
				balance;
17. A description of the
				nature, type, terms, and conditions of all securities options issued by the
				applicant, including the title and amount of securities subject to
				option;
18. The name and address of
				each option holder in
(a)17 above, the
				options held, and the market value at the time of issuance;
19. Information regarding any
				transaction within the last five years involving a change in the beneficial
				ownership of the business entity's equity securities on the part of any current
				or former director, officer, or beneficial owner of more than 10 percent of any
				class of equity security, including the date and nature of the transaction, the
				parties to the transaction, including positions, and the names of the
				securities involved;
20. Copies of
				the following documents:
i. The last
				definitive Proxy or Information Statement filed pursuant to any securities
				laws;
ii. All Registration
				Statements filed in the last five years pursuant to any securities laws;
				and
iii. All reports and
				correspondence, submitted in the last five years by independent auditors for
				the business entity, which pertain to the issuance of financial statements,
				managerial advisory services, or internal control recommendations, including
				the name, address, and telephone number of the current outside
				auditor(s).