0001004724-14-000040.txt : 20140404 0001004724-14-000040.hdr.sgml : 20140404 20140404160445 ACCESSION NUMBER: 0001004724-14-000040 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20140404 DATE AS OF CHANGE: 20140404 EFFECTIVENESS DATE: 20140404 FILER: COMPANY DATA: COMPANY CONFORMED NAME: ADCARE HEALTH SYSTEMS, INC CENTRAL INDEX KEY: 0001004724 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 311332119 STATE OF INCORPORATION: GA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-214960 FILM NUMBER: 14745981 BUSINESS ADDRESS: STREET 1: 1145 HEMBREE ROAD CITY: ROSWELL STATE: GA ZIP: 30076 BUSINESS PHONE: 404-781-2895 MAIL ADDRESS: STREET 1: 1145 HEMBREE ROAD CITY: ROSWELL STATE: GA ZIP: 30076 FORMER COMPANY: FORMER CONFORMED NAME: ADCARE HEALTH SYSTEMS INC DATE OF NAME CHANGE: 19951208 D 1 primary_doc.xml X0707 D LIVE 0001004724 ADCARE HEALTH SYSTEMS, INC 1145 HEMBREE ROAD ROSWELL GA GEORGIA 30076 404-781-2895 GEORGIA ADCARE HEALTH SYSTEMS INC Corporation true David A. Tenwick 1145 Hembree Road Rosell GA GEORGIA 30076 Director Christopher F. Brogdon 1145 Hembree Road Roswell GA GEORGIA 30076 Director Boyd P. Gentry 1145 Hembree Road Roswell GA GEORGIA 30076 Executive Officer Director Peter J. Hackett 1145 Hembree Road Roswell GA GEORGIA 30076 Director Philip S. Radcliffe 1145 Hembree Road Rosewell GA GEORGIA 30076 Director Laurence E. Sturtz 1145 Hembree Road Roswell GA GEORGIA 30076 Director Michael J. Fox 1145 Hembree Road Roswell GA GEORGIA 30076 Director Ronald W. Fleming 1145 Hembree Road Roswell GA GEORGIA 30076 Executive Officer David Rubenstein 1145 Hembree Road Roswell GA GEORGIA 30076 Executive Officer Other Health Care Decline to Disclose 06b false 2014-03-28 false true true true true false 25000 GVC Capital LLC 38923 Institutional Securities Corporation 20291 5350 S. Roslyn St., Suite 400 Greenwood Village CO COLORADO 80111 AL ALABAMA CO COLORADO LA LOUISIANA OK OKLAHOMA OR OREGON TX TEXAS false 6500000 6500000 0 Represents sale of subordinated promissory notes, convertible into shares of common stock at a conversion price per share of $4.50. In connection with such sale, a warrent to purchase 53,333 shares was issued to the placement agent. See 15. false 32 240000 0 Excludes equity compensation to placement agent of a five-year warrant to purchase 53,333 shares of common stock at $4.50 per share exercise price. 0 false ADCARE HEALTH SYSTEMS, INC /s/ BOYD P. GENTRY Boyd P. Gentry President and Chief Executive Officer 2014-04-04