0001209191-11-015675.txt : 20110304 0001209191-11-015675.hdr.sgml : 20110304 20110304172855 ACCESSION NUMBER: 0001209191-11-015675 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110302 FILED AS OF DATE: 20110304 DATE AS OF CHANGE: 20110304 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Zak Kowalczyk Mary CENTRAL INDEX KEY: 0001508729 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13498 FILM NUMBER: 11665836 MAIL ADDRESS: STREET 1: W140 N8981 LILLY ROAD CITY: MENOMONEE FALLS STATE: WI ZIP: 53051 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ASSISTED LIVING CONCEPTS INC CENTRAL INDEX KEY: 0000929994 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-NURSING & PERSONAL CARE FACILITIES [8050] IRS NUMBER: 931148702 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: W140 N8981 LILLY ROAD CITY: MENOMONEE FALLS STATE: WI ZIP: 53051 BUSINESS PHONE: 262-257-8888 MAIL ADDRESS: STREET 1: W140 N8981 LILLY ROAD CITY: MENOMONEE FALLS STATE: WI ZIP: 53051 4 1 doc4.xml FORM 4 SUBMISSION X0303 4 2011-03-02 0 0000929994 ASSISTED LIVING CONCEPTS INC ALC 0001508729 Zak Kowalczyk Mary W140 N8981 LILLY ROAD MENOMONEE FALLS WI 53051 0 1 0 0 Vice President Tandem Stock Options/SARs (right to buy) 31.71 2011-03-02 4 A 0 500 0.00 A 2011-03-03 2015-03-03 Class A Common Stock 500 1000 D /s/ Mary Zak-Kowalczyk 2011-03-04