-----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, J+7RLf/hnOyYMFvKLqsYw1oCJqu1e8MIBTDZf38O01SDBK6Tl1S6eELpXUJy9+b8 5b8UVBzEJ5PQqG/2sFtXcg== 0001047469-98-036891.txt : 19981012 0001047469-98-036891.hdr.sgml : 19981012 ACCESSION NUMBER: 0001047469-98-036891 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980925 FILED AS OF DATE: 19981009 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: REGENT ASSISTED LIVING INC CENTRAL INDEX KEY: 0001000693 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 931171049 STATE OF INCORPORATION: OR FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-27108 FILM NUMBER: 98723573 BUSINESS ADDRESS: STREET 1: 121 SW MORRISON ST STREET 2: STE 1000 CITY: PORTLAND STATE: OR ZIP: 97204 BUSINESS PHONE: 5032274000 MAIL ADDRESS: STREET 1: 121 SW MORRISON ST STREET 2: STE 1000 CITY: PORTLAND STATE: OR ZIP: 97204 COMPANY DATA: COMPANY CONFORMED NAME: LTC HEALTHCARE INC CENTRAL INDEX KEY: 0001059186 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-NURSING & PERSONAL CARE FACILITIES [8050] OWNER IRS NUMBER: 911895305 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 300 ESPLANADA DR STE 1860 CITY: OXNARD STATE: CA ZIP: 93030 BUSINESS PHONE: 8059818655 MAIL ADDRESS: STREET 1: 300 ESPLANADE DR STREET 2: STE 1860 CITY: OXNARD STATE: CA ZIP: 93030 FORMER COMPANY: FORMER CONFORMED NAME: LTC EQUITY HOLDING CO INC DATE OF NAME CHANGE: 19980403 4 1 FORM 4
- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------------- FORM 4 WASHINGTON, D.C. 20549 OMB APPROVAL - -------- ----------------------------- / / CHECK THIS BOX IF NO STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0287 LONGER SUBJECT TO EXPIRES: SEPTEMBER 30, 1998 SECTION 16. FORM 4 OR Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN FORM 5 OBLIGATIONS MAY Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 0.5 CONTINUE. SEE Section 30(f) of the Investment Company Act of 1940 ----------------------------- INSTRUCTION 1(b). (Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name AND Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director X 10% Owner LTC Healthcare, Inc. Regent Assisted Living, Inc. (RGNT) ---- ---- - --------------------------------------------------------------------------------------------- Officer (give Other (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- title ---- (specify Number of Reporting Month/Year below) below Person (Voluntary) ----------------- ------------------ 300 Esplanade Drive, Suite 1860 91-1895305 September 1998 - -------------------------------------------- --------------------- 7. Individual or Joint/Group Filing (Street) 5. If Amendment, (Check Applicable Line) Date of Original /X/ Form filed by One Reporting Person (Month/Year) ___Form filed by More than One Oxnard, CA 93030 Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action or Disposed of (D) Securities ship of In- Date Code (Instr. 3, 4 and 5) Beneficially Form: direct (Instr. 8) Owned at Direct Bene- (Month/ End of (D) or ficial Day/ ------------------------------------------- Month Indirect Owner- Year) (A) or (I) ship Code V Amount (D) Price (Instr. 3 (Instr. 4) (Instr. 4) and 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, no par value per share 9/25/98 P 69,000 A $4.375 69,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) * If the form is filed by more than one reporting person, SEE Instruction 4(b)(v). SEC 1474 (7-97) POTENTIAL PERSONS WHO ARE TO 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.
FORM 4 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- 6. Date Exer- (Instr. 3) sion or action tion Code ative Securities Ac- cisable and Ex- Exercise Date (Instr. 8) quired (A) or Dis- piration Date Price of (Month/ posed of (D) (Month/Day/ Deriv- Day/ (Instr. 3, 4, and 5) Year) ative Year) Security -------------------- Date Expira- -------------------------------------- Exer- tion cisable Date Code V (A) (D) - ------------------------------------------------------------------------------------------------------------------------ 7.5% Convertible $7.50, subject September P 266,667 9/1/98 3/31/08 Subordinated Notes Due to adjustment 1, 1998 March 31, 2008 (the "Notes'') - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ 7. Title and Amount of Under- 8. Price 9. Number 10. Owner- 11. Nature lying Securities of of Deriv- ship of In- (Instr. 3 and 4) Deriv- ative Form direct ative Securi- of De- Bene- Secur- ties rivative ficial ity Bene- Secu- Own- (Instr. ficially rity: ership 5) Owned Direct (Instr. 4) at End (D) or Amount or of Indi- Title Number of Month rect (I) Shares (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------ Common 266,667 $7.50 1,133,333* (D) Stock - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------ Explanation of Responses: By: /s/ PAMELA J. PRIVETT October 9, 1998 --------------------------------- --------------- **Intentional misstatements or omissions of facts constitute **Signature of Reporting Person Date 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2 SEC 1474 (7-97)
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