0001047335-15-000128.txt : 20151104 0001047335-15-000128.hdr.sgml : 20151104 20151104163453 ACCESSION NUMBER: 0001047335-15-000128 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151102 FILED AS OF DATE: 20151104 DATE AS OF CHANGE: 20151104 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NATIONAL HEALTHCARE CORP CENTRAL INDEX KEY: 0001047335 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 522057472 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 VINE ST STREET 2: STE 1400 CITY: MURFREESBORO STATE: TN ZIP: 37130 BUSINESS PHONE: 6158902020 MAIL ADDRESS: STREET 1: 100 VINE ST STREET 2: STE 1400 CITY: MURFREESBORO STATE: TN ZIP: 37130 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DANIEL DONALD K CENTRAL INDEX KEY: 0001012857 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13489 FILM NUMBER: 151197401 MAIL ADDRESS: STREET 1: P.O. BOX 1398 CITY: MURFREESBORO STATE: TN ZIP: 37133-1398 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2015-11-02 0001047335 NATIONAL HEALTHCARE CORP NHC 0001012857 DANIEL DONALD K 100 VINE ST., SUITE 1200 MURFREESBORO TN 37130 0 1 0 0 Sr. Vice President, Controller Shares of Common Stock 2015-11-02 4 C 0 242 0 A 265581 I Partnership Option to purchase Common Stock 46.69 2012-12-04 2016-02-29 Common Stock 39859 21000 D Shares of Series A Convertible Preferred Stock 2015-11-02 4 C 0 1000 0 D 2007-11-01 2015-11-03 Common Stock 242 140073 D Shares of Series A Convertible Preferred Stock 2015-11-03 4 J 0 140073 15.79 D 2007-11-01 2015-11-03 Common Stock 33903 0 D The Form 5 filed 2/9/2015 should have reported 244,339 shares of common stock. The difference of 27 shares is added to this line's total. Convertible anytime at a ratio of 0.24204 common shares per 1.0 preferred share. The Filer converted 1,000 shares of Series A Convertible Preferred into Common Stock at the conversion rate of 0.24204 common shares per preferred share. The reported securities were called for redemption by the issuer at a price equal to $15.79 per share. /s/ Donald K. Daniel 2015-11-04