-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Sp3ZGayzIysafRZnzSmJwrpq02EBOZVCxqjFBO1kIGATYJDQkO6rJ0UG+PwAmGSY M+i5BG9QTKWBUq84VK3tnw== 0001181431-09-049062.txt : 20091029 0001181431-09-049062.hdr.sgml : 20091029 20091029172309 ACCESSION NUMBER: 0001181431-09-049062 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091027 FILED AS OF DATE: 20091029 DATE AS OF CHANGE: 20091029 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bachleda Simon A CENTRAL INDEX KEY: 0001471941 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34504 FILM NUMBER: 091145475 MAIL ADDRESS: STREET 1: 2401 SOUTH PLUM GROVE ROAD CITY: PALATINE STATE: IL ZIP: 60067 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Addus HomeCare Corp CENTRAL INDEX KEY: 0001468328 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOME HEALTH CARE SERVICES [8082] IRS NUMBER: 205340172 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2401 SOUTH PLUM GROVE ROAD CITY: PALATINE STATE: IL ZIP: 60067 BUSINESS PHONE: 847-303-5300 MAIL ADDRESS: STREET 1: 2401 SOUTH PLUM GROVE ROAD CITY: PALATINE STATE: IL ZIP: 60067 4 1 rrd255688.xml FORM 4 X0303 4 2009-10-27 0 0001468328 Addus HomeCare Corp ADUS 0001471941 Bachleda Simon A 320 PARK AVENUE, 9TH FLOOR NEW YORK NY 10022 1 0 1 0 Common Stock 2009-10-27 4 A 0 1000 0 A 1000 D Series A Convertible Preferred Stock Common Stock 4023000 4023000 I 3,125,520 shares by Eos Capital Partners III, L.P., and 897,480 by Eos Partners SBIC III, L.P. The convertible preferred stock is convertible at any time, at the holder's election, and has no expiration date. Immediately prior to the completion of the initial public offering of the issuer, the preferred stock will be converted into common stock for no additional consideration. Simon Bachleda is a director of the Issuer and a Principal of Eos Management, L.P. and its affiliates ("Eos"). As a result, Mr. Bachleda may be deemed to share beneficial ownership of the securities owned by Eos. Mr. Bachleda disclaims beneficial ownership of such securities, and this report shall not be deemed an admission that Mr. Bachleda is the beneficial owner of the securities for purposes of Section 16 or for any other purpose, except to the extent of his pecuniary interest therein. /s/ Simon A. Bachleda 2009-10-28 -----END PRIVACY-ENHANCED MESSAGE-----