New Jersey Administrative Code › Title 13 - LAW AND PUBLIC SAFETY › Chapter 69A - APPLICATIONS › Subchapter 5 - FORMS › Section 13:69A-5.15 - Business Entity Disclosure Form-Casino Service Industry Enterprise

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A Business
				Entity Disclosure Form Casino Service Industry Enterprise (BED CSI) shall be in
				a format prescribed by the Division and may require the enterprise to provide
				the following information:
1. The current or
				former official and trade names used and the dates of use;
2. The current and former business addresses
				within the last 10-year period and dates of use;
3. The business telephone number;
4. The name, title and telephone number of
				the contact person;
5. Whether the
				application is for initial licensure or retention of that license and, if
				retention, the license number and date of last submission;
6. If the license applicant is other than the
				enterprise filing this form, the reason for filing and the nature of the filing
				enterprise's relationship to the license applicant;
7. The business form and, as appropriate, a
				copy of the certificate of incorporation, charter, bylaws, partnership
				agreement and all amendments, trust agreement or other documentation relating
				to the legal organization of the enterprise;
8. If a publicly traded corporation, the
				stock exchange its stock is traded on and its symbol;
9. The Federal Employer Identification
				Number;
10. A description of the
				present and any former business engaged in or intended to be engaged in by the
				enterprise and any parent, holding, intermediary or subsidiary company within
				the past five years and similar information for former businesses for the past
				10 years;
11. A description of the
				nature, type, number of shares, terms, conditions, rights and privileges of all
				classes of stock issued by the enterprise, if any, and the amount outstanding
				of each, or which the enterprise plans to issue;
12. The name, address, date of birth (if
				appropriate), class of non-voting stock, number and percentage of shares held
				by each person or entity having a beneficial interest in any non-voting
				stock;
13. The name, home address,
				date of birth, current title or position and, if applicable, number of shares
				and class of stock and percentage of ownership for the following persons:
i. Each officer, director or
				trustee;
ii. Each partner whether
				general, limited or otherwise;
iii.
				A sole proprietor;
iv. Each natural
				person or entity that directly or indirectly holds any beneficial or ownership
				interest of five percent or more of the entity completing the form;
v. Each sales representative or other person
				who will regularly solicit business from a casino licensee;
vi. Each management person who supervises a
				regional or local office which employs sales or junket representatives or other
				persons who regularly solicit business from a casino hotel;
vii. Any other person not otherwise specified
				in (a)13i through vi above who has signed or will sign any agreement with a
				casino licensee;
viii. Each natural
				person who indirectly holds any beneficial or ownership interest of 10 percent
				or more of an applicant for a junket enterprise license; and
ix. If a junket enterprise, each junket
				representative who will deal directly with casino licensees and their
				employees;
14. A flow
				chart which illustrates the ownership of any other enterprise which holds an
				interest in the filing enterprise;
15. The name, last known address, date of
				birth, position, dates the position was held, and reason for leaving for any
				former officers or directors who held such office during the preceding 10
				years;
16. The annual compensation
				of each partner, officer, director and trustee;
17. The name, home address, date of birth,
				position, length of time employed and the amount of compensation of each
				person, other than the persons identified in (a)13 above, who is currently
				expected to receive annual compensation of more than $ 300,000;
18. A description of all bonus, profit
				sharing, pension, retirement, deferred compensation or similar plans in
				existence or to be created by the enterprise;
19. If the enterprise is a partnership, a
				description of the interest held by each partner, whether limited or general,
				amount of initial investment, amount of additional contribution, amount and
				nature of any anticipated future investments, degree of control of each
				partner, percentage of ownership of each partner, and method of distributing
				profits to each partner;
20. A
				description of the nature, type, terms, covenants, and priorities of all
				outstanding debt and the name, address and date of birth of each debtholder or
				security holder, type and class of debt instrument held, original debt amount
				and current debt balance;
21. A
				description of the nature, type, terms and conditions of all securities
				options;
22. Within the last 10
				years, the following information for each account held by a bank, savings and
				loan association or other financial institution, whether foreign or domestic,
				in the name of the enterprise or its nominee or which is otherwise under the
				direct or indirect control of the enterprise:
i. The name and address of the financial
				institution;
ii. The type of
				account;
iii. The account numbers;
				and
iv. The dates held;
23. A description of the top 10
				dollar value contracts or agreements with individuals including name, address
				and nature of the contract or goods or service provided during the past
				year;
24. The name and address of
				each company in which the enterprise holds stock, type of stock held, purchase
				price per share, number of shares held, and percentage of ownership indicating
				any holding of five percent or more of ownership held;
25. Information regarding any transaction
				during the past five years involving a change in the beneficial ownership of
				the enterprise's securities on the part of an officer or director who owned
				more than 10 percent of any class of equity security either directly or
				indirectly;
26. A description of
				any civil, criminal, administrative and investigatory proceedings in any
				jurisdiction in which the enterprise or its subsidiaries have been involved as
				follows:
i. Any arrest, indictment, charge or
				conviction for any criminal or disorderly persons offense;
ii. Any criminal proceeding in which the
				enterprise or its subsidiaries has been a party or has been named as an
				unindicted co-conspirator;
iii.
				Existing civil litigation if damages are reasonably expected to exceed $
				100,000, except for claims covered by insurance;
iv. Any judgment, order, consent decree or
				consent order entered against the enterprise pertaining to a violation or
				alleged violation of the Federal antitrust, trade regulation or securities laws
				or similar laws of any state, province or country; and
v. Any judgment, order, consent decree or
				consent order entered against the enterprise pertaining to a violation or
				alleged violation of any other state or Federal statute, regulation or code
				which resulted in the imposition of a fine or penalty of $ 50,000 or
				more;
27. Within the
				last 10 years, for the enterprise and any holding or intermediary company,
				information regarding any judgments or petitions by or against it for
				bankruptcy or insolvency and any relief sought under any provision of the
				Federal Bankruptcy Act or any state insolvency law, and any receiver, fiscal
				agent, trustee, reorganization trustee, or similar officer appointed for the
				property or business of the enterprise or its parent, any holding, intermediary
				or subsidiary company;
28. Within
				the last 10 years, whether the enterprise has had any license or certificate
				denied, suspended or revoked by any government agency in this State or any
				other jurisdiction, the nature of such license or certificate, the agency and
				its location, the date of such action, the disposition, the reasons therefor,
				and the facts related thereto;
29.
				Whether the enterprise has ever applied for a license, permit or authorization
				to participate in any lawful gaming operation in this State or any other
				jurisdiction, the agency and its location, date of application, the nature of
				the license permit or authorization, number and expiration date;
30. Within the last 10 years, whether the
				enterprise or any director, officer, partner, employee or person acting for or
				on behalf of the enterprise has made bribes or kickbacks to any employee,
				company, organization or government official, foreign or domestic, to obtain
				favorable treatment or to obtain a competitive advantage;
31. Within the last 10 years, whether the
				enterprise has:
i. Donated or loaned its funds
				or property for the use or benefit of or in opposing or supporting any
				government, political party, candidate or committee, either foreign or
				domestic;
ii. Made any loans,
				donations or disbursements to its directors, officers, partners or employees
				for the purpose of making political contributions or reimbursing such
				individuals for political contributions either foreign or domestic;
				or
iii. Maintained a bank account
				or other account, either foreign or domestic, not reflected on its books or
				records, or maintained any account in the name of a nominee for the
				enterprise;
32. The
				names and addresses of any current or former directors, officers, partners,
				employees or third parties who would have knowledge or information concerning
				(a)30 and 31 above;
33. A copy of
				each of the following:
i. Annual reports for
				the past five years;
ii. If the
				enterprise is a corporation registered under the Securities Act of 1933 or the
				Securities Exchange Act of 1934, any annual reports prepared within the last
				five years on Form 10K pursuant to the Securities Exchange Act of
				1934;
iii. An audited financial
				statement for the last fiscal year, including, without limitation, an income
				statement, balance sheet and statement of sources and application of funds, and
				all notes to such statements and related financial schedules;
iv. Copies of all annual financial
				statements, whether audited or unaudited, prepared in the last five fiscal
				years, any exceptions taken to such statements by an independent auditor and
				the management response thereto;
v.
				Any current report prepared due to a change in control of the enterprise, an
				acquisition or disposition of assets, a bankruptcy or receivership proceeding,
				a change in the enterprise's certifying accountant or any other material event,
				or, if the enterprise is registered with the SEC, a copy of the most recently
				filed Form 8K;
vi. The most recent
				Proxy or Information Statement filed pursuant to Section 14 of the Securities
				Exchange Act of 1934; and
vii.
				Registration Statements filed in the last five years pursuant to the Securities
				Act of 1933;
34. An
				organizational chart of the enterprise, including position descriptions and the
				name of the person holding each position;
35. Copies of all Internal Revenue Forms 1120
				(corporate income tax return), all Internal Revenue Forms 1065 (partnership
				return) or all Internal Revenue Forms 1040 (personal return) filed for the last
				five years; and
36. A copy of a
				business registration certificate or other proof of valid business registration
				with the Division of Revenue in the New Jersey Department of the
				Treasury.