SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Diversicare Healthcare Services, Inc. [ DVCR ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 11/03/2021 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 11/03/2021 | G | V | 55,000(1) | D | $0.00(2) | 243,423 | D | ||
Common Stock | 11/19/2021 | D(3) | 243,423 | D | $10.1(4) | 0 | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
2021 Restricted Stock Units | (5) | 11/19/2021 | D(3) | 13,463 | (6) | 03/16/2023 | Common Stock | 13,463 | (6) | 0 | D | ||||
2020 Restricted Stock Units | (5) | 11/19/2021 | D(3) | 13,235 | (6) | 03/13/2022 | Common Stock | 13,235 | (6) | 0 | D |
Explanation of Responses: |
1. On November 3, 2021, the reporting person made a charitable gift of 55,000 shares. |
2. Bona Fide Gift. No compensation was given to the donor for the gifting of shares. |
3. Disposition pursuant to the terms of the Agreement and Plan of Merger dated as of August 26, 2021 by and among DAC Acquisition, LLC, DVCR Acquisition Corporation and Diversicare Healthcare Services, Inc. (the "Merger Agreement"), exempt under Rule 16b-3. |
4. Pursuant to the terms of the Merger Agreement, at the Effective Time (as defined in the Merger Agreement), each share of common stock held by the reporting person immediately prior to the Effective Time was cancelled and the reporting person received an amount in cash equal to $10.10 per share of Company Common Stock, taking into account any changes thereto by reason of the merger. |
5. Each restricted stock unit is equal to one share. |
6. Pursuant to the terms of the Merger Agreement, at the Effective Time, each Restricted Stock Unit held by the reporting person immediately prior to the Effective Time was cancelled and the reporting person received an amount in cash equal to $10.10 per share of Company Common Stock represented by each such Restricted Stock Unit, taking into account any changes thereto by reason of the merger. |
Remarks: |
/s/ Susan V. Sidwell, Attorney-In-Fact for James R. McKnight, Jr. | 11/22/2021 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |