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