0001179110-12-017130.txt : 20121207 0001179110-12-017130.hdr.sgml : 20121207 20121207160533 ACCESSION NUMBER: 0001179110-12-017130 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121205 FILED AS OF DATE: 20121207 DATE AS OF CHANGE: 20121207 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CARLINO PETER M CENTRAL INDEX KEY: 0001211342 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24206 FILM NUMBER: 121249995 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: HOTELS & MOTELS [7011] 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 4 1 edgar.xml FORM 4 - X0306 4 2012-12-05 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 2012-12-05 4 J 0 152683 0 A 1562500 D Common Stock 2012-12-05 4 J 0 36281 0 A 1598781 D The reporting person is also the indirect beneficial owner of (a) 6,905,874 shares which are owned by the Carlino Family Trust a 9.0% owner of the issuer of which Peter M. Carlino is a Trustee; and (b) 156,151 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; and (b) 21,659 shares owned by a GRAT executed by Peter M. Carlino on 5/19/06. 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 reporting person is also the indirect beneficial owner by reason of his status as the Trustee of each of the following trusts under the 2008 Grantor Retained Annuity Trust No. 2 of Peter M. Carlino dtd 11/20/2008: (a) f/b/o Peter W. Carlino (34,804 shares), (b) f/b/o Christopher P. Carlino (34,804 shares) (c) f/b/o Kelly E. Masano (34,804 shares) and (d) f/b/o Kathleen J. Schippers (34,804 shares). Mr. Carlino disclaims beneficial ownership of the shares owned by all of these trusts, 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 reporting person is also the indirect beneficial owner by reason of his status as the Trustee of each of the following trusts under the 2008 GRAT of Marshia W. Carlino dtd 11/20/2008: (a) f/b/o Peter W. Carlino (40,580 shares), (b) f/b/o Christopher P. Carlino (40,579 shares) (c) f/b/o Kelly E. Masano (40,580 shares) and (d) f/b/o Kathleen J. Schippers (40,580 shares). Mr. Carlino disclaims beneficial ownership of the shares owned by all of these trusts, 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 reported shares were owned by Marshia W. Carlino, the wife of Peter M. Carlino, and were transferred to joint ownership with Peter M. Carlino, resulting in Mr. Carlino having direct beneficial ownership and a pecuniary interest in the reported shares. Shares acquired by Peter M. Carlino as a beneficiary under the Carlino Family Trust. /s/Robert S Ippolito as attorney-in-fact for Peter M. Carlino 2012-12-07