1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Common Stock Option (right to buy)
|
03/16/2015 |
03/16/2017 |
Common Stock
|
3,150
(2)
|
$
3.93
|
D
|
Â
|
Common Stock Option (right to buy)
|
Â
(3)
|
04/17/2023 |
Common Stock
|
4,500
(3)
|
$
4.3
|
D
|
Â
|
* |
If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) |
Restricted Stock Award granted on January 1, 2016 under the AdCare Health Systems, Inc. 2011 Stock Plan. The shares will vest on the following schedule: (i) 2,597 shares on 1/1/2017; (ii) 2,597 shares on 1/1/2018; and (iii) 2,598 shares on 1/1/2019. |
(2) |
Options granted on March 16, 2012 under the AdCare Health Systems, Inc. 2011 Stock Plan. The options vested on the following schedule: (i) 1,050 options on 3/16/2013; (ii) 1,050 options on 3/16/2014; and (iii) 1,050 options on 3/16/2015. |
(3) |
Options granted on April 17, 2013 under the AdCare Health Systems, Inc. 2011 Stock Plan. The options vest on the following schedule: (i) 1,500 options on 4/17/2014; (ii) 1,500 options on 4/17/2015; and (iii) 1,500 options on 4/17/2016. |