0001209191-12-018925.txt : 20120319 0001209191-12-018925.hdr.sgml : 20120319 20120319132345 ACCESSION NUMBER: 0001209191-12-018925 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120315 FILED AS OF DATE: 20120319 DATE AS OF CHANGE: 20120319 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: 12700018 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 X0304 4 2012-03-15 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) 17.01 2012-03-15 4 A 0 2200 0.00 A 2013-03-15 2017-03-15 Class A Common Stock 2200 2200 D Award of tandem non-qualified stock options and stock appreciation rights for shares of the Issuer's Class A Common Stock ("Option/SARs") approved on March 15, 2012. The exercise price is the closing price of the Issuer's Class A Common Stock on the New York Stock Exchange on March 15, 2012. The award also includes up to 8,800 additional Options/SARs which are contingent upon the attainment of certain performance criteria in 2012. The Options/SARs vest in three equal annual installments beginning on March 15, 2013. /s/Mary T. Zak-Kowalczyk 2013-03-19