0001209191-13-036669.txt : 20130715 0001209191-13-036669.hdr.sgml : 20130715 20130715174026 ACCESSION NUMBER: 0001209191-13-036669 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130711 FILED AS OF DATE: 20130715 DATE AS OF CHANGE: 20130715 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Zak Kowalczyk Mary CENTRAL INDEX KEY: 0001508729 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-13498 FILM NUMBER: 13969012 MAIL ADDRESS: STREET 1: W140 N8981 LILLY ROAD CITY: MENOMONEE FALLS STATE: WI ZIP: 53051 4/A 1 doc4a.xml FORM 4/A SUBMISSION X0306 4/A 2013-07-11 2013-07-11 1 0000929994 ASSISTED LIVING CONCEPTS INC ALC 0001508729 Zak Kowalczyk Mary 608 REDTAIL LANE COLGATE WI 53017 0 1 0 0 Vice President Class A Common Stock 2013-07-11 4 D 0 1334 12.00 D 0 D Tandem Stock Options/SARs (right to buy) 7.68 2013-07-11 4 D 0 2666 4.33 D 2014-02-22 Class A Common Stock 2666 0 D Tandem Stock Options/SARs (right to buy) 15.86 2013-07-11 4 D 0 2000 0.00 D 2015-03-03 Class A Common Stock 2000 0 D Tandem Stock Options/SARs (right to buy) 18.69 2013-07-11 4 D 0 11000 0.00 D 2016-03-02 Class A Common Stock 11000 0 D Tandem Stock Options/SARs (right to buy) 17.01 2013-07-11 4 D 0 2200 0.00 D 2017-03-15 Class A Common Stock 2200 0 D Pursuant to the Agreement and Plan of Merger (the "Merger Agreement") dated as of February 25, 2013 among Aid Holdings, LLC, Aid Merger Sub, LLC and Assisted Living Concepts, Inc. ("ALC"), on July 11, 2013, each share of Class A Common Stock of ALC was converted into the right to receive $12.00 in cash. Pursuant to the Merger Agreement, on July 11, 2013, each Tandem Stock Option/SAR (whether or not then exercisable or vested), which began vesting in three equal annual installments beginning on the date four years prior to its expiration date, was cancelled and converted into the right to receive a cash payment in an amount equal to the excess, if any, of $12.00 over the exercise price of such Tandem Stock Option/SAR. Reason for Amendment: The box next to "Check this box if no longer subject to Section 16. . ." should have been checked. /s/ Mary Zak-Kowalczyk 2013-07-11