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*
CAMPBELL LESLIE

(Last) (First) (Middle)
1261 GALLERIA BOULEVARD

(Street)
BRENTWOOD TN 37027

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Diversicare Healthcare Services, Inc. [ DVCR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
COO and Executive VP
3. Date of Earliest Transaction (Month/Day/Year)
03/12/2015
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 03/12/2015 M 372 A $0.00(1) 40,602 D
Common Stock 03/12/2015 F(2) 1,420 D $0.00 39,182 D
Common Stock 03/12/2015 M 114 A $0.00(1) 39,296 D
Common Stock 03/12/2015 F(3) 1,132 D $0.00 38,164 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Dividend Equivalent Rights on 2013 Restricted Shares (4) 03/12/2015 M 372 (4) (4) Common Stock 372 $0.00(1) 374.91 D
Dividend Equivalent Rights on 2014 Restricted Shares (5) 03/12/2015 M 114 (5) (5) Common Stock 114 $0.00(1) 226.42 D
2014 Restricted Stock Units (6) (7) (7) Common Stock 5,432.48 5,432.48 D
2015 Restricted Stock Units (8) (9) (9) Common Stock 8,604.21 8,604.21 D
Explanation of Responses:
1. Represents vesting of dividend equivalent.
2. This transaction represents shares withheld by the Company for tax withholdings on Ms. Campbell's vesting of 2013 Restricted Stock.
3. This transaction represents shares withheld by the Company for tax withholdings on Ms. Campbell's vesting of 2014 Restricted Stock.
4. These dividend equivalent rights accrued on shares of restricted stock granted on March 12, 2013 and will vest as the underlying shares vest.
5. These dividend equivalent rights accrued on restricted stock granted on March 12, 2014 and will vest as the underlying shares vest.
6. Each restricted stock unit is equal to one share.
7. The 2014 Restricted Stock Units shall vest and be exercisable in full on the 2nd anniversary of their original Grant Date (3/12/2014).
8. Ms. Campbell elected to receive $90,000 of her cash bonus for 2014 in Restricted Stock Units under the terms of the Advocat Inc. 2008 Stock Purchase Plan for Key Personnel. Each Restricted Stock Unit is equal to one share.
9. The 2015 Restricted Stock Units shall vest and be exercisable in full on the 2nd anniversary of their original Grant Date (3/10/2015).
Remarks:
/s/ Jonathan D. Stanley, Attorney-in-Fact for Leslie Campbell 03/16/2015
** 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.