-----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, RxIStLy5jqXPN5nwIm+GoQfYZfWCz9+XPWo8RdjDVll896OKp2wAFe11OeIutceD Svn5B/Jr87b63E7MbB718g== 0001047469-98-013883.txt : 19980407 0001047469-98-013883.hdr.sgml : 19980407 ACCESSION NUMBER: 0001047469-98-013883 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980326 FILED AS OF DATE: 19980406 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: 3 SEC ACT: SEC FILE NUMBER: 000-27108 FILM NUMBER: 98588207 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 EQUITY HOLDING CO INC CENTRAL INDEX KEY: 0001059186 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] OWNER IRS NUMBER: 911895305 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 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 3 1 FORM 3 - ------ FORM 3 - ------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------ WASHINGTON, D.C. 20549 OMB APPROVAL INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES OMB NUMBER 3235-0104 EXPIRES: SEPTEMBER 30, 1998 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section ESTIMATED AVERAGE BURDEN 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) HOURS PER RESPONSE 0.5 of the Investment Company Act of 1940 ------------------------------ (Print or Type Responses) - ----------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting 2. Date of Event 4. Issuer Name and Ticker or Trading Symbol Person* Requiring Statement (Month/Day/Year) Regent Assisted Living, Inc. (RGNT) LTC Healthcare, Inc. March 26, 1998 - ----------------------------------------------------------------------------------------------------------------------------------- 3. I.R.S. 5. Relationship of Reporting Person(s) 6. If Amendment, Date of Identification to Issuer Original Number of (Check all applicable) (Month/Day/Year) Reporting Person, if an entity Director X 10% Owner 300 Esplanade Drive, Suite 1860 (voluntary) ------ ------ ----------------------------- - ------------------------------------ Officer Other 7. Individual or (Street) ------ ------- Joint/Group Filing 91-1895305 (give title below) (specify below) (Check Applicable Line) X Form filed by One ----------------------------------- --- Reporting Person --- Form filed by More Oxnard, California 93030 than One Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial Ownership (Instr. 4) Beneficially Owned Form: (Instr. 5) (Instr. 4) Direct (D) or Indirect (I) (Instr. 5) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities (PAGE 1 of 2) beneficially owned directly or indirectly. SEC 1473 (7/97) *If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v)
Potential persons who are to respond to the collection of inforamtion contained in this form are not required to respond unless the form displays a currently valid OMB control number FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of 2. Date Exercisable and 3. Title and Amount 4. Conversion 5. Ownership Form 6. Nature of Derivative Expiration Date of Securities or Exercise of Derivative Indirect Security (Month/Day/Year) Underlying Price of Security: Direct Beneficial (Instr. 4) Derivative Security Derivative (D) or Indirect (I) Ownership (Instr. 4) Security (Instr. 5) (Instr. 5) ------------------------------------------------------- Date Expiration Amount or Number Exercisable Date Title of Shares - ----------------------------------------------------------------------------------------------------------------------------------- 7.5% Convertible March 30, March 31, Common Stock, 533,333* $7.50, subject (D) Subordinated Notes Due 1998 2008 no par value to adjustment March 31, 2008 (the "Notes") - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: * Regent Assisted Living, Inc. has an option to require LTC Healthcare, Inc. to purchase up to an additional $6 million principal amount of Notes (convertible into up to 800,000 additional shares of Common Stock at a conversion price of $7.50 per share, subject to adjustment). Such option must be exercised on or prior to March 31, 2000. ** 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 provided 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. LTC HEALTHCARE, INC. By: /s/ Pamela J. Privett April 6, 1998 ----------------------------------------- --------------- **Signature of Reporting Person Date Name: Pamela J. Privett Title: Senior Vice President, General Counsel and Secretary (Page 2 of 2) -----END PRIVACY-ENHANCED MESSAGE-----