-----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, KpRTjQ6s4pZCSdSgFW20BoJmYsSL5kVBiOywLWNMl7a4HcJHSWCYDwfpdZcn7wKM hSeQTmDyPTxEGoul+sDlwA== 0000906602-98-000160.txt : 19980515 0000906602-98-000160.hdr.sgml : 19980515 ACCESSION NUMBER: 0000906602-98-000160 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980331 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: 4/A SEC ACT: SEC FILE NUMBER: 000-22261 FILM NUMBER: 98620915 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: DERMER HARRY CENTRAL INDEX KEY: 0001060534 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FILING VALUES: FORM TYPE: 4/A BUSINESS ADDRESS: STREET 1: 725 TOWN HILL RD CITY: NEW HARTFORD STATE: CT ZIP: 06057 BUSINESS PHONE: 8602236902 MAIL ADDRESS: STREET 1: 725 TOWN HILL RD CITY: NEW HARTFORD STATE: CT ZIP: 06057 4/A 1
FORM 4 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 / / Check this box if STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP no longer subject to Section 16. Form 4 or Form 5 obligations may Filed pusuant to Section 16(a) of the Securities Exchange Act of 1934, continue. Section 17(a) of the Public Utility Holding Company Act of 1935 See Instruction 1(b). or Section 30(f) of the Investment Company Act of 1940 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading 6. Relationship of Reporting Person to Symbol Issuer (Check all applicable) Dermer Harry Lexington Healthcare Group, Inc. (LEXI) (Last) (First) (Middle) 3. IRS Identifi- 4. Statement for _X_ Director _X_ 10% Owner cation Number of Month/Year Reporting Person, March, 1998 _X_ Officer ___ Other if an entity (give title (specify below) 725 Town Hill Road (Voluntary) below) (Street) President and COO New Hartford CT 06057 (City) (State) (Zip) 5. If Amendment, 7. Individual or Joint/Group Filing Date of Original (Check Applicable Line) Month/Year _X_ Form filed by One Reporting Person April 9, 1998 ___ Form filed by More than One Reporting Person
Table 1 -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1. Title of Security 2. Trans- 3. 4. Securities 5. Amount of 6. Owner- 7. Nature of (Instr. 3) action Trans- Acquired (A) Securities ship Form: Indirect Date action or Disposed of (D) Beneficially Direct Beneficial Code (Instr. 3,4 and 5) Owned at End of (D) or Ownership (Month (Instr.8) (A) Month Indirect /Day/ or (I) Year) Code V Amount (D) Price (Instr.3 and 4) (Instr. 4) (Instr. 4) Common Stock 5/13/97 J(1) 615,500 A (1) D Common Stock 5/22/97 J(2) 60,000 A (2) D Common Stock 685,500 D *If the form is filed by more than one reporting person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (OVER) (Print or Type Response)
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FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of 2.Con- 3.Tran- 4.Tran- 5. Number 6.Date 7.Title and 8.Price 9.Number 10.Own- 11.Na Derivative version saction saction of Deriv- Exer- Amount of of of ship ture Security or Date Code ative cisable and Underlying Deriv- Deriv- Form of In- (Instr.3) Exercise (Month/ (Instr. Securities Expiration Securities ative ative of direct Price Day/ 8) Acquired Date (Instr.3 and 4) Secur- Secur- Deriv- Bene- of Year) (A) or (Month/Day ity ities ative ficial Deriv- Disposed Year) (Instr.5) Bene- Secur- Own- ative of (D) ficially ity: ship Security (Inst.3,4, Owned Direct (Instr. and 5) at End (D) or 4) of Indirect Month (I) (Instr.4) (Instr.4) Code V (A) (D) Date Expir- Title Amount Exer- ation or cisable Date Number of Shares Employee Stock Option (right to buy) $2.625 12/17/97 A 60,000 (3) 12/16/03Common 60,000 60,000 D Stock
Explanation of Responses: See Page 3.
By: /s/ Harry Dermer 5/13/98 ** Signature of Reporting Person Date Name: Harry Dermer ** 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.
Page 2 of 3 FORM 4 (continued) Item 1: Harry Dermer 725 Town Hill Road New Hartford, CT 06057 Item 2: Lexington Healthcare Group, Inc. (LEXI) Item 4: March, 1998 Explanation of Responses: (1) The reporting person acquired these shares of Common Stock from the Issuer in exchange for a 25% interest in Lexington Health Care Group, LLC. (2) The reporting person acquired these shares of Common Stock from the Issuer in exchange for a 20% interest in BALZ Medical Services, Inc. (3) The option becomes exercisable in three equal annual installments beginning on December 17, 1998. Page 3 of 3 -----END PRIVACY-ENHANCED MESSAGE-----