The Ohio Casino Control Commission has unanimously approved a gambling license for the Cincinnati Horseshoe Casino, the fourth and final casino approved by voters in 2009. The license was granted despite concerns about the financial condition of Caesars Entertainment, management company of the Cincinnati and Cleveland casinos. Caesars has $22 billion in debt and there is concern they may file for bankruptcy. As a result, the commission added stipulations. Caesars will be subject to an annual financial review and they will be required to notify the state if they intend to file for bankruptcy or make any other major financial move.