0001209191-16-089042.txt : 20160105 0001209191-16-089042.hdr.sgml : 20160105 20160105172457 ACCESSION NUMBER: 0001209191-16-089042 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20151231 FILED AS OF DATE: 20160105 DATE AS OF CHANGE: 20160105 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Diversicare Healthcare Services, Inc. CENTRAL INDEX KEY: 0000919956 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 621559667 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1621 GALLERIA BLVD. CITY: BRENTWOOD STATE: TN ZIP: 37027 BUSINESS PHONE: 6157717575 MAIL ADDRESS: STREET 1: 1621 GALLERIA BLVD. CITY: BRENTWOOD STATE: TN ZIP: 37027 FORMER COMPANY: FORMER CONFORMED NAME: ADVOCAT INC DATE OF NAME CHANGE: 19940309 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CAMPBELL LESLIE CENTRAL INDEX KEY: 0001565686 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12996 FILM NUMBER: 161323744 MAIL ADDRESS: STREET 1: 1621 GALLERIA BOULEVARD CITY: BRENTWOOD STATE: TN ZIP: 37027 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-12-31 0 0000919956 Diversicare Healthcare Services, Inc. DVCR 0001565686 CAMPBELL LESLIE 1261 GALLERIA BOULEVARD BRENTWOOD TN 37027 0 1 0 0 COO and Executive VP Common Stock 38164 D Dividend Equivalent Rights on 2013 Restricted Shares 2015-12-31 4 A 0 36.77 0.00 A Common Stock 36.77 485.6 D Dividend Equivalent Rights on 2014 Restricted Shares 2015-12-31 4 A 0 58.56 0.00 A Common Stock 58.56 402.7 D Dividend Equivalent Rights on 2015 Restricted Shares 2015-12-31 4 A 0 85.52 0.00 A Common Stock 85.52 257.44 D 2014 Restricted Stock Units 2015-12-31 4 A 0 37.17 0.00 A Common Stock 37.17 5544.37 D 2015 Restricted Stock Units 2015-12-31 4 A 0 58.86 0.00 A Common Stock 58.86 8781.4 D These dividend equivalent rights accrued on shares of restricted stock granted on March 12, 2013 and will vest as the underlying shares vest. Represents vesting of dividend equivalent. These dividend equivalent rights accrued on restricted stock granted on March 12, 2014 and will vest as the underlying shares vest. These dividend equivalent rights accrued on restricted stock granted on March 10, 2015 and will vest as the underlying shares vest. Each restricted stock unit is equal to one share. The 2014 Restricted Stock Units shall vest and be exercisable in full on the 2nd anniversary of their original Grant Date (3/12/2014). The 2015 Restricted Stock Units shall vest and be exercisable in full on the 2nd anniversary of their original Grant Date (3/10/2015). /s/ Jonathan D. Stanley, Attorney-in-Fact for Leslie Campbell 2016-01-05 EX-24.4_623492 2 poa.txt POA DOCUMENT LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS Know all by these presents, that the undersigned hereby constitutes and appoints each of Jonathan D. Stanley, Kelly J. Gill and Susan V. Sidwell signing singly, the undersigned's true and lawful attorney-in-fact to: (1) execute for and on behalf of the undersigned, in the undersigned's capacity as an officer and/or director of Advocat Inc. (the "Company"), Forms 3, 4, and 5 in accordance with Section 16(a) of the Securities and Exchange Act of 1934 and the rules thereunder; (2) do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; (3) execute for and on behalf of the undersigned a Form ID and any subsequent filings, submissions or correspondence relating thereto; and (4) take any and all other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-fact's discretion The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities and Exchange Act of 1934. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact. This Power of Attorney replaces and revokes any and all prior powers of attorney granted by the undersigned, in the undersigned's capacity as an officer and/or director of the Company, relating to Section 16 of the Securities Exchange Act of 1934. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 28th day of December, 2012. /s/ Leslie Campbell Signature Leslie Campbell Print Name