-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, HHrGOl5oJd3cImL4cOhNUWqpA/Cg8PIlDeqLY67z9TDAbElaSD6QISQMMbrk2Q6b xGwaP6i+rHexOOgf9QJw8w== 0001179110-09-002856.txt : 20090217 0001179110-09-002856.hdr.sgml : 20090216 20090217174859 ACCESSION NUMBER: 0001179110-09-002856 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20081231 FILED AS OF DATE: 20090217 DATE AS OF CHANGE: 20090217 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CARLINO PETER M CENTRAL INDEX KEY: 0001211342 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24206 FILM NUMBER: 09616148 BUSINESS ADDRESS: BUSINESS PHONE: 6103732400 MAIL ADDRESS: STREET 1: 825 BERKSHIRE BLVD STREET 2: SUITE 200 CITY: WYOMISSING STATE: PA ZIP: 19610 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PENN NATIONAL GAMING INC CENTRAL INDEX KEY: 0000921738 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS AMUSEMENT & RECREATION [7990] IRS NUMBER: 232234473 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 825 BERKSHIRE BLVD STE 200 STREET 2: WYOMISSING PROFESSIONAL CENTER CITY: WYOMISSING STATE: PA ZIP: 19610 BUSINESS PHONE: 6103732400 MAIL ADDRESS: STREET 1: 825 BERSHIRE BLVD STREET 2: SUITE 200 CITY: WYOMISSING STATE: PA ZIP: 19610 5 1 edgar.xml FORM 5 - X0303 5 2008-12-31 0 0 0 0000921738 PENN NATIONAL GAMING INC PENN 0001211342 CARLINO PETER M 825 BERKSHIRE BLVD SUITE 200 WYOMISSING PA 19610 1 1 0 0 Chairman & CEO Common Stock 2008-10-30 5 G 0 48549 0 D 438549 D Common Stock 2008-10-30 5 G 0 48549 0 A 0 I By Wife The reporting person is also the indirect beneficial owner of (a) 8,872,838 shares which are owned by the Carlino Family Trust a greater than 10% owner of the issuer of which Peter M. Carlino is a Trustee; and (b) 201,806 shares, which are owned by The Trust for Gary Gilbert, of which Peter M. Carlino is a Trustee. Peter M. Carlino disclaims beneficial ownership of the shares owned by each of the Carlino Family Trust and The Trust for Gary Gilbert, and this report should not be deemed an admission that Peter M. Carlino is the beneficial owner of such securities for the purpose of section 16 or any other purpose. The reporting person is also the indirect beneficial owner of (a) 231,380 shares owned by a Grantor Retained Annuity Trust (a GRAT) executed by Peter M. Carlino on 9/23/05; (b) 21,659 shares owned by GRAT executed by Peter M. Carlino on 5/19/06;(c) 63,945 shares owned by a GRAT executed by Peter M. Carlino on 6/14/07; (d)509,303 shares owned by a GRAT executed by Peter M. Carlino on 6/26/08; (e) 270,165 shares owned by a GRAT executed by Peter M. Carlino on 11/20/08; and (f) 315,002 shares owned by a GRAT executed by Marshia W. Carlino on 11/20/08. Mr. Carlino is the Trustee of each of the GRATs. Mr. Carlino disclaims beneficial ownership of the shares owned by all of the GRATs, and this report should not be deemed an admission that Peter M. Carlino is the beneficial owner of such securities for purposes of Section 16 or any other purpose. The 48,549 shares that were gifted to Marshia W., Carlino, Mr. Carlino's wife, were contributed to a GRAT executed by her on 11/20/08 and reported in footnote (2), of which Mr. Carlino is the Trustee. Peter M. Carlino and Marshia W. Carlino are joint owners of 76,698 of the shares reported as held by him directly. /s/Robert S Ippolito as attorney-in-fact for Peter M. Carlino 2009-02-17 -----END PRIVACY-ENHANCED MESSAGE-----