FORM 3
        
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response...
0.5
                      
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

Fillmore CCA Investment, LLC

2. Date of Event Requiring Statement (MM/DD/YYYY)
9/19/2013 

3. Issuer Name and Ticker or Trading Symbol

ClubCorp Holdings, Inc. [MYCC]

(Last)        (First)        (Middle)

100 FILLMORE STREET, SUITE 600

4. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                            ___ X ___ 10% Owner
_____ Officer (give title below)          _____ Other (specify below)

(Street)

DENVER, CO 80206       

(City)              (State)              (Zip)
5. If Amendment, Date Original Filed (MM/DD/YYYY)

 

6. Individual or Joint/Group Filing (Check Applicable Line)

_ X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person


Table I - Non-Derivative Securities Beneficially Owned
1.Title of Security
(Instr. 4)
2. Amount of Securities Beneficially Owned
(Instr. 4)
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
4. Nature of Indirect Beneficial Ownership
(Instr. 5)
Common Stock   50569730   (1) D    

Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 4)
2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
4. Conversion or Exercise Price of Derivative Security 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
6. Nature of Indirect Beneficial Ownership
(Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares

Explanation of Responses:
( 1)  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.

Remarks:
Exhibit List: Exhibit 24 - Power of Attorney

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
Fillmore CCA Investment, LLC
100 FILLMORE STREET
SUITE 600
DENVER, CO 80206

X


Signatures
/s/ Ingrid Keiser, by power of attorney 9/19/2013
** Signature of Reporting Person Date


Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5(b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
CLUBCORP HOLDINGS, INC. (NYSE:MYCC)
過去 株価チャート
から 6 2024 まで 7 2024 CLUBCORP HOLDINGS, INC.のチャートをもっと見るにはこちらをクリック
CLUBCORP HOLDINGS, INC. (NYSE:MYCC)
過去 株価チャート
から 7 2023 まで 7 2024 CLUBCORP HOLDINGS, INC.のチャートをもっと見るにはこちらをクリック