-----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, IZtRlijWBKiGNlZD1FBCbrSIZ0L7wtU3e8JzrG3fHS5oLIoPfIOxhow5Bbx6I4bi pUpboica50DjIuzic2lCBg== 0000906602-98-000159.txt : 19980515 0000906602-98-000159.hdr.sgml : 19980515 ACCESSION NUMBER: 0000906602-98-000159 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19970514 FILED AS OF DATE: 19980514 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LEXINGTON HEALTHCARE GROUP INC CENTRAL INDEX KEY: 0001026348 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 061468252 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-22261 FILM NUMBER: 98620877 BUSINESS ADDRESS: STREET 1: 35 PARK PL CITY: NEW BRITAIN STATE: CT ZIP: 06052 BUSINESS PHONE: 8602236902 MAIL ADDRESS: STREET 1: 35 PARK PLACE CITY: NEW BRITTAIN STATE: CT ZIP: 06052 COMPANY DATA: COMPANY CONFORMED NAME: ARCHAMBAULT MARY P CENTRAL INDEX KEY: 0001060535 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 35 PARK PL CITY: NEW BRITAIN STATE: CT ZIP: 06052 BUSINESS PHONE: 8602236902 MAIL ADDRESS: STREET 1: 230 GERALDINE DR CITY: COVENTRY STATE: CT ZIP: 06238 3 1
FORM 3 U. S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 INITIAL STATEMENT OF 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(f) of the Investment Company Act of 1940 1. Name and Address of Reporting Person* 2. Date of Event 4. Issuer Name AND Ticker or Trading Symbol Requiring Lexington Healthcare Group, Inc. (LEXI) Archambault Mary P. Statement (Last) (First) (Middle) (Month/Day/Year) 5/14/97 3.IRS Identification 5. Relationship of Reporting 6. If Amendment, Number of Person(s) to Issuer Date of Original 230 Geraldine Drive Reporting Person, (Check all applicable) (Month/Day/Year) (Street) if an entity ____ Director ____ 10% Owner (Voluntary) _X__ Officer (give ____ Other (specify title below) below) Coventry CT 06238 Executive Vice President and Secretary (City) (State) (Zip) -------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) _X_Form filed by One Reporting Person ___Form filed by More than One Reporting Person TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED 1. Title of Security 2. Amount of 3. Ownership Form: Direct (D) or 4.Nature of (Instr. 4) Securities Indirect (I) Indirect Beneficially (Instr. 5) Benficial Owned Ownership (Instr. 4) (Instr. 5) No securities owned * If the form is filed by more than one reporting person, see Instruction 5(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses)
FORM 3 (continued) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security 2.Date Exer- 3.Title and Amount of Securities 4.Conver- 5.Owner- 6.Nature of (Instr. 4) cisable Underlying Derivative Security sion or ship Indirect and (Instr. 4) Exercise Form of Beneficial Expiration Price Deriv- Ownership Date of ative (Instr. 5) (Month/Day/ Deri- Security: Year) vative Direct Date Expira- Amount Security (D) or Exer- tion Title or Indirect cisable Date Number (I) of (Instr. 5) Shares
Explanation of Responses:
/s/ Mary Archmabault 05.13.98 ** 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. Page 2 (Print or Type Responses)
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