13D Filing: Park City Capital, Llc and Adcare Health Systems Inc (NYSEMKT:ADK)

1

NAME OF REPORTING PERSON

PARK CITY CAPITAL OFFSHORE MASTER, LTD.

2

CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP

(a)
☐
(b) ☐

3

SEC USE ONLY

4

SOURCE OF FUNDS

WC

5

CHECK IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT
TO ITEM 2(d) or 2(e)

☐

6

CITIZENSHIP OR PLACE OF ORGANIZATION

Cayman Islands

NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON WITH

7

SOLE VOTING POWER 0

8

SHARED VOTING POWER 976,168*

9

SOLE DISPOSITIVE POWER 0

10

SHARED DISPOSITIVE POWER 976,168*

11

AGGREGATE AMOUNT BENEFICIALLY OWNED BY REPORTING PERSON

976,168*

12

CHECK IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES

☐

13

PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)

4.9%

14

TYPE OF REPORTING PERSON

CO

Page 2 of 8 – SEC Filing

1	NAME OF REPORTING PERSON PARK CITY CAPITAL OFFSHORE MASTER, LTD.
2	CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP			(a) ☐ (b) ☐
3	SEC USE ONLY
4	SOURCE OF FUNDS WC
5	CHECK IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEM 2(d) or 2(e)			☐
6	CITIZENSHIP OR PLACE OF ORGANIZATION Cayman Islands
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH		7	SOLE VOTING POWER 0
		8	SHARED VOTING POWER 976,168*
		9	SOLE DISPOSITIVE POWER 0
		10	SHARED DISPOSITIVE POWER 976,168*
11	AGGREGATE AMOUNT BENEFICIALLY OWNED BY REPORTING PERSON 976,168*
12	CHECK IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES			☐
13	PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 4.9%
14	TYPE OF REPORTING PERSON CO