SEC Form 4 · accession 0001047335-15-000128
NATIONAL HEALTHCARE CORP · NHC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Donald K Daniel
Officer — Sr. Vice President, Controller
Period of report
Nov 2, 2015
Accepted (ET)
Nov 4, 2015 · 4:34 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001047335
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Shares of Common StockF1 | Nov 2, 2015 | C | 242 | $0.00 | A | 265,581 | I | Partnership |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Shares of Series A Convertible Preferred StockF3,F2 | — | Nov 2, 2015 | C | 1,000 | D | Nov 1, 2007 | Nov 3, 2015 | Common Stock | 242 | 140,073 | D |
| Shares of Series A Convertible Preferred StockF4,F2 | — | Nov 3, 2015 | J | 140,073 | D | Nov 1, 2007 | Nov 3, 2015 | Common Stock | 33,903 | 0 | D |
| Option to purchase Common Stock | $46.69 | holding | — | — | — | Dec 4, 2012 | Feb 29, 2016 | Common Stock | 39,859 | 21,000 | D |
Explanation of responses
- F1The Form 5 filed 2/9/2015 should have reported 244,339 shares of common stock. The difference of 27 shares is added to this line's total.
- F2Convertible anytime at a ratio of 0.24204 common shares per 1.0 preferred share.
- F3The Filer converted 1,000 shares of Series A Convertible Preferred into Common Stock at the conversion rate of 0.24204 common shares per preferred share.
- F4The reported securities were called for redemption by the issuer at a price equal to $15.79 per share.