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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Common Stock Option (right to purchase) | $ 6.3 | 03/25/2013 | M | 42,374 | (4) | 12/03/2013 | Common Stock | 42,374 | (5) | 14,166 | D | ||||
Common Stock Option (right to purchase) | $ 6.3 | 03/26/2013 | M | 14,166 | (4) | 12/03/2013 | Common Stock | 14,166 | (5) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
JOHANNESSEN KEITH N 14160 DALLAS PARKWAY SUITE 300 DALLAS, TX 75254 |
X | President & COO |
/s/ Keith N. Johannessen | 03/26/2013 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The total number of shares reported corrects a de minimis error in the reporting person's previous Form 4 filed on March 8, 2013 (the "Prior Form 4"). The Prior Form 4 reported the forfeiture of 1,038 shares of performance-based restricted stock when in actuality 1,039 shares of performance-based restricted stock were forfeited. |
(2) | A portion of the sale proceeds will be used by the reporting person to satisfy tax liabilities. As indicated in the table above, the options were scheduled to expire on December 3, 2013 if not exercised prior to such date. |
(3) | The price reported in Column 4 is a weighted average price. The shares were sold in multiple transactions at prices ranging from $26.45 to $26.52, inclusive. The reporting person undertakes to provide Capital Senior Living Corporation, any stockholder of Capital Senior Living Corporation, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote. |
(4) | The options vested in three installments of 33%, 33% and 34% on December 4, 2004, December 4, 2005 and December 4, 2006, respectively. |
(5) | Granted on December 4, 2003 pursuant to the Capital Senior Living Corporation 1997 Omnibus Stock Incentive Plan. |
(6) | The price reported in Column 4 is a weighted average price. The shares were sold in multiple transactions at prices ranging from $26.50 to $26.77, inclusive. The reporting person undertakes to provide Capital Senior Living Corporation, any stockholder of Capital Senior Living Corporation, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote. |