0001104659-13-071155.txt : 20130919 0001104659-13-071155.hdr.sgml : 20130919 20130919180021 ACCESSION NUMBER: 0001104659-13-071155 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20130919 FILED AS OF DATE: 20130919 DATE AS OF CHANGE: 20130919 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ClubCorp Holdings, Inc. CENTRAL INDEX KEY: 0001577095 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEMBERSHIP SPORTS & RECREATION CLUBS [7997] IRS NUMBER: 205818205 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3030 LBJ FREEWAY, SUITE 500 CITY: DALLAS STATE: TX ZIP: 75234 BUSINESS PHONE: 972-406-4112 MAIL ADDRESS: STREET 1: 3030 LBJ FREEWAY, SUITE 500 CITY: DALLAS STATE: TX ZIP: 75234 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Fillmore CCA Investment, LLC CENTRAL INDEX KEY: 0001586570 STATE OF INCORPORATION: DE FISCAL YEAR END: 1213 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36074 FILM NUMBER: 131106329 BUSINESS ADDRESS: STREET 1: 100 FILLMORE STREET STREET 2: SUITE 600 CITY: DENVER STATE: CO ZIP: 80206 BUSINESS PHONE: 720-284-6400 MAIL ADDRESS: STREET 1: 100 FILLMORE STREET STREET 2: SUITE 600 CITY: DENVER STATE: CO ZIP: 80206 3 1 a3.xml 3 X0206 3 2013-09-19 0 0001577095 ClubCorp Holdings, Inc. MYCC 0001586570 Fillmore CCA Investment, LLC 100 FILLMORE STREET SUITE 600 DENVER CO 80206 0 0 1 0 Common Stock 50569730 D These shares represent shares of common stock, par value $0.01 per share ("Common Stock") of ClubCorp Holdings, Inc. (the "Issuer") that are directly held by Fillmore CCA Investment, LLC ("Fillmore"). Fillmore will sell shares in the initial public offering of the Issuer. In connection with the initial public offering of the Issuer, it is expected that Fillmore will distribute shares of common stock of the Issuer to the holders of Class A Units and Class C Units of Fillmore in exchange for their units of Fillmore. Exhibit List: Exhibit 24 - Power of Attorney /s/ Ingrid Keiser, by power of attorney 2013-09-19 EX-24 2 ex-24.htm EX-24 Exhibit 24

Exhibit 24

 

POWER OF ATTORNEY

 

The undersigned does hereby nominate, constitute and appoint Steven S. Siegel and Ingrid J. Keiser, the undersigned’s true and lawful attorneys and agents to do any and all acts and things and execute and file any and all instruments which said attorneys and agents may deem necessary or advisable to enable the undersigned (in the undersigned’s individual capacity or in any other capacity) to comply with the Securities Exchange Act of 1934 (the “34 Act”) and the Securities Act of 1933 (the “33 Act”) and any requirements of the Securities and Exchange Commission (the “SEC”) in respect thereof, in connection with the preparation, execution and/or filing of (i) any report or statement of beneficial ownership or changes in beneficial ownership of securities of ClubCorp Holdings, Inc., a Nevada corporation (the “Company”), that the undersigned (in the undersigned’s individual capacity or in any other capacity) may be required to file pursuant to Section 16(a) of the 34 Act, including any report or statement on Form 3, Form 4 or Form 5, or to any amendment thereto, (ii) any report or notice required under Rule 144 of the 33 Act, including Form 144, or any amendment thereto, and (iii) any and all other documents or instruments that may be necessary or desirable in connection with or in furtherance of any of the foregoing, including Form ID, or any amendments thereto, and any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required pursuant to Section 16(a) of the 34 Act or any rule or regulation of the SEC, such power and authority to extend to any form or forms adopted by the SEC in lieu of or in addition to any of the foregoing and to include full power and authority to sign the undersigned’s name in his or her individual capacity or otherwise, hereby ratifying and confirming all that said attorneys and agents shall do or cause to be done by virtue thereof.

 

This authorization shall supersede all prior authorizations to act for the undersigned with respect to securities of the Company in such matters, which prior authorizations are hereby revoked, and shall remain in effect until revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

 

IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of September, 2013.

 

 

FILLMORE CCA INVESTMENT, LLC

 

 

 

 

 

By:

/s/ Steven S. Siegel

 

 

Name:

Steven S. Siegel

 

 

Title:

Director