-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: keymaster@town.hall.org Originator-Key-Asymmetric: MFkwCgYEVQgBAQICAgADSwAwSAJBALeWW4xDV4i7+b6+UyPn5RtObb1cJ7VkACDq pKb9/DClgTKIm08lCfoilvi9Wl4SODbR1+1waHhiGmeZO8OdgLUCAwEAAQ== MIC-Info: RSA-MD5,RSA, Gq+h+90A1ZQTDhbkNSS4N9uTHiXi8DLqCfNgbcsRbv0qcJSl+ExZN2pDT1EUqnV5 mPAhQj4doU9nTryvThamoA== 0000033939-94-000012.txt : 19940824 0000033939-94-000012.hdr.sgml : 19940824 ACCESSION NUMBER: 0000033939-94-000012 CONFORMED SUBMISSION TYPE: SC 13D/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19940823 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FORUM RETIREMENT PARTNERS L P CENTRAL INDEX KEY: 0000804752 STANDARD INDUSTRIAL CLASSIFICATION: 8300 IRS NUMBER: 351686799 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-41402 FILM NUMBER: 94545693 BUSINESS ADDRESS: STREET 1: 8900 KEYSTONE CROSSING STE 200 STREET 2: PO BOX 40498 CITY: INDIANAPOLIS STATE: IN ZIP: 46240 BUSINESS PHONE: 3178460700 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: FORUM GROUP INC CENTRAL INDEX KEY: 0000033939 STANDARD INDUSTRIAL CLASSIFICATION: 8300 IRS NUMBER: 610703072 STATE OF INCORPORATION: IN FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: SC 13D/A BUSINESS ADDRESS: STREET 1: 8900 KEYSTONE CROSSING STE 200 STREET 2: P O BOX 40498 CITY: INDIANAPOLIS STATE: IN ZIP: 46240-0498 BUSINESS PHONE: 3178460700 MAIL ADDRESS: STREET 1: 8900 KEYSTONE CROSSING STE 200 STREET 2: PO BOX 40498 CITY: INDIANAPOLIS STATE: IN ZIP: 46240-0498 FORMER COMPANY: FORMER CONFORMED NAME: EXCEPTICON INC DATE OF NAME CHANGE: 19810909 FORMER COMPANY: FORMER CONFORMED NAME: GUARDIAN CARE CORP DATE OF NAME CHANGE: 19720615 SC 13D/A 1 FORUM RETIREMENT PARTNERS, L.P. 13D/A SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13D (Amendment No. 4) Under the Securities Exchange Act of 1934 Forum Retirement Partners, L.P. ------------------------------- (Name of Issuer) Partnership Preferred Depositary Units -------------------------------------- (Title of Class of Securities) 349 851 105 -------------- (CUSIP Number) Forum Group, Inc. 8900 Keystone Crossing Suite 200 Indianapolis, Indiana 46240-0498 Attention: John H. Sharpe, Esq. (317) 846-0700 --------------------------------------------- (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) August 23, 1994 ------------------------------------ (Date of Event which Requires Filing of this Statement) If the filing person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because of Rule 13d-1(b)(3) or (4), check the following box [ ]. Check the following box if a fee is being paid with this statement [ ]. Page 1 of 8 Pages SCHEDULE 13D CUSIP NO. 349 851 105 Page 2 of 8 Pages - -------------------------------------------------------------------------- NAME OF REPORTING PERSONS 1 S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Forum Group, Inc. - -------------------------------------------------------------------------- CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) 2 (b) x - -------------------------------------------------------------------------- SEC USE ONLY 3 - -------------------------------------------------------------------------- SOURCE OF FUNDS* 4 WC - -------------------------------------------------------------------------- CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT 5 TO ITEMS 2(d) or 2(e) ( ) - -------------------------------------------------------------------------- CITIZENSHIP OR PLACE OF ORGANIZATION 6 Indiana - -------------------------------------------------------------------------- 7 SOLE VOTING POWER NUMBER OF SHARES BENEFICIALLY OWNED 4,130,980 Units BY EACH REPORTING ------------------------------------------- PERSON WITH 8 SHARED VOTING POWER 0 ------------------------------------------- 9 SOLE DISPOSITIVE POWER 4,130,980 Units ------------------------------------------- 10 SHARED DISPOSITIVE POWER 0 - -------------------------------------------------------------------------- AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 11 8,636,791 Units - -------------------------------------------------------------------------- CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN 12 SHARES* ( ) - -------------------------------------------------------------------------- PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 13 56.5% - -------------------------------------------------------------------------- TYPE OF REPORTING PERSON* 14 CO - -------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! SCHEDULE 13D CUSIP NO. 349 851 105 Page 3 of 8 Pages - -------------------------------------------------------------------------- NAME OF REPORTING PERSONS 1 S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Forum A/H, Inc. - -------------------------------------------------------------------------- CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) 2 (b) x - -------------------------------------------------------------------------- SEC USE ONLY 3 - -------------------------------------------------------------------------- SOURCE OF FUNDS* 4 AF WC - -------------------------------------------------------------------------- CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO 5 ITEMS 2(d) or 2(e) ( ) - -------------------------------------------------------------------------- CITIZENSHIP OR PLACE OF ORGANIZATION 6 Delaware - -------------------------------------------------------------------------- 7 SOLE VOTING POWER NUMBER OF SHARES BENEFICIALLY OWNED 4,505,811 Units BY EACH REPORTING ------------------------------------------- PERSON WITH 8 SHARED VOTING POWER 0 ------------------------------------------- 9 SOLE DISPOSITIVE POWER 4,505,811 Units ------------------------------------------- 10 SHARED DISPOSITIVE POWER 0 - -------------------------------------------------------------------------- AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 11 8,636,791 Units - -------------------------------------------------------------------------- CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN 12 SHARES* ( ) - ------------------------------------------------------------------------- PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 13 56.5% - -------------------------------------------------------------------------- TYPE OF REPORTING PERSON* 14 CO - -------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! This Amendment No. 4 amends and supplements the Statement on Schedule 13D filed on August 24, 1993 (as heretofore amended and supplemented, the "Schedule 13D"), by Forum Group, Inc., an Indiana corporation. Capitalized terms used herein not otherwise defined have the respective meanings ascribed to them in the Schedule 13D. Item 3. Source and Amount of Funds or Other Consideration. -------------------------------------------------- Item 3 is hereby amended by adding the following at the end thereof: On August 23, 1994, FGI purchased a total of 2,190,712 Units for an aggregate purchase price of $5,781,464 (such purchases being hereinafter referred to as the "August 23 Purchases"). See Schedule IV hereto for specific information with respect to the August 23 Purchases. The funds required by FGI to pay the purchase price for the Units purchased by it in the August 23 Purchases were obtained from FGI's existing cash balances. Item 4. Purpose of Transaction. ----------------------- Item 4 is hereby amended by deleting it in its entirety and substituting the following therefor: The responses to Items 3, 5 and 6 are incorporated herein by this reference. FGI's principal purpose in consummating the August 23 Purchases was to increase its equity interest in the Partnership. FGI or Forum A/H may at any time acquire additional Units or take other action with respect to the Partnership or any of its securities in any manner permitted by law, including the acquisition of additional Units in open-market purchases, in additional privately negotiated transactions, in a tender or exchange offer or other form of business combination, or a combination of any of the foregoing. There can be no assurance as to whether any such transaction or action described in this Item 4 will be consummated or taken, or as to the possible timing or terms thereof. Item 5. Interest in Securities of the Issuer. ------------------------------------- Item 5 is hereby amended by deleting the second paragraph thereof in its entirety and substituting the following therefor: Immediately following the August 23 Purchases, (i) FGI directly owned 4,130,980 Units, constituting 27.0% of the total number of Units outstanding, as to which, subject to the terms of the Partnership Agreement, it had sole voting and dispositive power, and (ii) Forum A/H (FGI's wholly owned subsidiary) directly owned 4,505,811 Units, 4 constituting 29.5% of the total number of Units outstanding, as to which, subject to the terms of the Partnership Agreement and the security agreement described below, it had sole voting and dispositive power. By reason of the relationship described in Item 2 above, FGI may be deemed to own beneficially the Units owned directly by Forum A/H. Further, FGI and Forum A/H may be deemed to constitute a "group" within the meaning of Rule 13d-5 under the Exchange Act. Item 6. Contracts, Arrangements, Understandings or Relationships with Respect to the Securities of the Issuer. -------------------------------------------- Item 6 is hereby amended by (i) deleting the third, fifth and sixth paragraphs thereof in their entirety and (ii) adding the following immediately prior to the last paragraph thereof: Pursuant to a security agreement, dated as of April 15, 1994, made by Forum A/H to Citicorp USA, Inc., as agent, Forum A/H has pledged 3,900,000 of the Units owned directly by it, and the right to receive amounts due under or pursuant to the Partnership Agreement with respect to such Units, to secure a letter of credit issued by Citibank, N.A. in the face amount of $6,883,336.08, which letter of credit was issued as security for a letter of credit issued by Chemical Bank with respect to municipal bonds issued to finance a rental retirement community currently leased by a subsidiary of FGI. 5 SCHEDULE IV INFORMATION REGARDING THE AUGUST 23 PURCHASES --------------------------------------------- Number Aggregate Description of Units Purchase Per Unit of Acquired Price Purchase Price Transaction - --------- ---------- -------------- ----------- 1,040,644 $3,121,932 $3.00 Privately negotiated transaction 1,150,068 $2,659,532 $2.3125 Privately negotiated transaction 6 SIGNATURE After reasonable inquiry and to the best of its knowledge and belief, the undersigned certifies that the information set forth in this statement is true, complete and correct and agrees that this statement may be filed jointly with Forum A/H, Inc. Dated: August 23, 1994 FORUM GROUP, INC. By:/s/ Troy B. Lewis ----------------- Troy B. Lewis, Attorney-in-fact* - -------------------- * Pursuant to a Power of Attorney executed on behalf of Forum Group, Inc. and previously filed as Exhibit 7 to the Schedule 13D. 7 SIGNATURE After reasonable inquiry and to the best of its knowledge and belief, the undersigned certifies that the information set forth in this statement is true, complete and correct and agrees that this statement may be filed jointly with Forum Group, Inc. Dated: August 23, 1994 FORUM A/H, INC. By:/s/ Troy B. Lewis ----------------- Troy B. Lewis, Attorney-in-fact* - -------------------- * Pursuant to a Power of Attorney executed on behalf of Forum A/H and previously filed as Exhibit 7 to the Schedule 13D. 8 -----END PRIVACY-ENHANCED MESSAGE-----