0001209191-11-026857.txt : 20110509 0001209191-11-026857.hdr.sgml : 20110509 20110509144523 ACCESSION NUMBER: 0001209191-11-026857 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110509 FILED AS OF DATE: 20110509 DATE AS OF CHANGE: 20110509 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Buntain Derek CENTRAL INDEX KEY: 0001379324 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13498 FILM NUMBER: 11822794 MAIL ADDRESS: STREET 1: 111 W MICHIGAN ST CITY: MILWAUKEE STATE: WI ZIP: 53203 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 2011-05-09 0 0000929994 ASSISTED LIVING CONCEPTS INC ALC 0001379324 Buntain Derek UNIT #5 PLANTANA 1293 WEST BAY ROAD GRAND CAYMAN E9 Grand Caym CAYMAN ISLANDS 1 0 0 0 Tandem Stock Option/SARs (right to buy) 34.97 2011-05-05 4 A 0 5000 0.00 A 2012-05-02 2016-05-02 Class A Common Stock 5000 5000 D Award of Options/SARs approved on May 2, 2011. The exercise price is the closing price of the Issuer's Class A Common Stock on the New York Stock Exchange on May 5, 2011, the second business day following the Issuer's public release of quarterly financial results. The Options/SARs vest in three equal annual installments beginning on May 2, 2012. /s/ Derek Buntain 2011-05-09