SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Brogdon Christopher F

(Last) (First) (Middle)
2 BUCKHEAD PLAZA
3050 PEACHTREE ROAD, SUITE 570

(Street)
ATLANTA GA 30305

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ADCARE HEALTH SYSTEMS INC [ ADK ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Acquisition Officer
3. Date of Earliest Transaction (Month/Day/Year)
07/09/2009
4. If Amendment, Date of Original Filed (Month/Day/Year)
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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 09/13/2011 X 89,662 A $2.38 172,151 D
Common Stock 09/13/2011 X 29,085 A $2.38 438,313 I By spouse
Common Stock 09/16/2011 X 372,750 A $2.38 811,063 I By spouse
Common Stock 09/26/2011 X 3,465 A $2.38 814,528(1) I By spouse
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant $2.38(2) 09/13/2011 X(3) 85,392 (4) 12/07/2014 Common Stock 89,662(2) $2.38 0 D
Warrant $2.38(2) 07/09/2009 P 500 (4) 11/10/2011 Common Stock 525(2) $0.35 515,500(5) I By spouse
Warrant $2.38(2) 09/13/2011 X(3) 27,700 (4) 12/07/2014 Common Stock 29,085(2) $2.38 487,800 I By spouse
Warrant $2.38(2) 09/15/2011 S 100,000 (4) 12/07/2014 Common Stock 105,000(2) $2.2 387,800 I By spouse
Warrant $2.38(2) 09/16/2011 S 29,500 (4) 12/07/2014 Common Stock 30,975(2) $2.2 358,300 I By spouse
Warrant $2.38(2) 09/16/2011 X(3) 355,000 (4) 12/07/2014 Common Stock 372,750(2) $2.38 3,300 I By spouse
Warrant $2.38(2) 09/26/2011 X(3) 3,300 (4) 12/07/2014 Common Stock 3,465(2) $2.38 0(6) I By spouse
Explanation of Responses:
1. The Reporting Person no longer has a reportable benefical interest in any of the shares of the Issuer's common stock owned by the Reporting Person's daughter and included in the Reporting Person's prior ownership reports.
2. The Warrants were subject to a 5% stock dividend issued by the Issuer on September 30, 2010. As a result of such stock dividend, the exercise price of the Warrants decreased from $2.50 to $2.38 and each Warrant became issuable for 1.05 shares of the Issuer's common stock.
3. The Warrants were exercised in connection with a call by the Issuer to redeem the Warrants pursuant to their terms.
4. The Warrants were exercisable on the transaction date.
5. The ownership of these Warrants was unreported at the time of the transaction and was omitted from the Reporting Person's subsequent Forms 4.
6. The Reporting Person no longer has a reportable benefical interest in any of the Issuer's warrants owned by the Reporting Person's daughter and included in the Reporting Person's prior ownership reports.
Remarks:
/s/ Christopher F. Brogdon 10/05/2011
** 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 4 (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 Number.