Statement of Changes in Beneficial Ownership (4)
March 13 2013 - 6:13PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Gill Kelly J.
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2. Issuer Name
and
Ticker or Trading Symbol
ADVOCAT INC
[
AVCA
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
CEO & President
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(Last)
(First)
(Middle)
1621 GALLERIA BOULEVARD
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3. Date of Earliest Transaction
(MM/DD/YYYY)
3/11/2013
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(Street)
BRENTWOOD, TN 37027
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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3/11/2013
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M
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120
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A
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$0.00
(1)
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29925
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D
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Common Stock
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3/12/2013
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M
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332
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A
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$0.00
(2)
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30257
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D
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Common Stock
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3/12/2013
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A
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25000
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A
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$0.00
(3)
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55257
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Dividend Equivalent Rights on 2011 Restricted Stock
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(4)
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3/11/2013
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M
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120
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(4)
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(4)
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Common Stock
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120
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$0.00
(1)
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120.22
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D
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2011 Restricted Stock Units
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(5)
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(6)
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(6)
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Common Stock
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6536.43
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6536.43
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D
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Dividend Equivalent Rights on 2012 Restricted Stock
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(7)
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3/12/2013
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M
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332
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(7)
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(7)
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Common Stock
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332
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$0.00
(2)
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665.09
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D
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2013 Restricted Stock Units
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(8)
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3/12/2013
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A
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13199.06
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(9)
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(9)
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Common Stock
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13199.06
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$0.00
(8)
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13199.06
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D
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2012 Restricted Stock Units
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(5)
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(10)
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(10)
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Common Stock
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8649.38
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8649.38
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D
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Stock Options (right to buy)
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$5.60
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11/10/2011
(11)
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11/10/2021
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Common Stock
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50000
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50000
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D
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Stock Settled Stock Appreciation Right
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$6.21
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4/5/2011
(11)
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4/5/2020
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Common Stock
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35000
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35000
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D
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Stock Settled Stock Appreciation Right
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$5.45
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6/18/2011
(11)
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6/18/2020
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Common Stock
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15000
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15000
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D
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Explanation of Responses:
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(
1)
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Represents vesting of Dividend Equivalent Rights on 2011 Restricted Stock.
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(
2)
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Represents vesting of Dividend Equivalent Rights on 2012 Restricted Stock.
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(
3)
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Restricted stock grant that will vest in equal parts over the first three anniversaries of the date of grant.
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(
4)
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These dividend equivalent rights accrued on shares of restricted stock granted on March 11, 2011 and will vest as the underlying shares vest.
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(
5)
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Each Restricted Stock Unit is equal to one share.
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(
6)
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The 2011 Restricted Stock Units shall vest and be exercisable in full on the 2nd anniversary of their original Grant Date.
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(
7)
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These dividend equivalent rights accrued on shares of restricted stock granted on March 12, 2012 and will vest as the underlying shares vest.
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(
8)
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Mr. Gill elected to receive $56,228 of his cash bonus for 2012 in Restricted Stock Units under the terms of the Advocat Inc. 2008 Stock Purchase Plan for Key Personnel. Each Restricted Stock Unit is equal to one share.
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(
9)
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The 2013 Restricted Stock Units shall vest and be exercisable in full on the 2nd anniversary of their original Grant Date (03/12/2013).
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(
10)
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The 2012 Restricted Stock Units shall vest and be exercisable in full on the 2nd anniversary of their original Grant Date (03/12/2012).
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(
11)
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Vests 1/3 on the first anniversary of the date of grant, 1/3 on the second anniversary of the date of grant, and 1/3 on the third anniversary of the date of grant.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Gill Kelly J.
1621 GALLERIA BOULEVARD
BRENTWOOD, TN 37027
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X
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CEO & President
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Signatures
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Jonathan D. Stanley, Attorney-in-Fact for
Kelly J. Gill
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3/13/2013
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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