-----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, BAOow/+3VVNcbb3WwLiqrEtjhcz1HI4h62loqlKwvSfH8YaGXxhRqtN+Vo1NM8j2 9vo7+he0KJ5vVr+G9ien9w== 0000033939-94-000013.txt : 19941014 0000033939-94-000013.hdr.sgml : 19941014 ACCESSION NUMBER: 0000033939-94-000013 CONFORMED SUBMISSION TYPE: SC 13D/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19941013 SROS: NONE 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: 94552494 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. 5) 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) October 12, 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 6 Pages SCHEDULE 13D CUSIP NO. 349 851 105 Page 2 of 6 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 4,921,980 Units BY EACH REPORTING ------------------------------------------- PERSON WITH 8 SHARED VOTING POWER 0 ------------------------------------------- 9 SOLE DISPOSITIVE POWER 4,921,980 Units ------------------------------------------- 10 SHARED DISPOSITIVE POWER 0 - -------------------------------------------------------------------------- AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 11 9,427,791 Units - -------------------------------------------------------------------------- CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN 12 SHARES* ( ) - -------------------------------------------------------------------------- PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 13 61.7% - -------------------------------------------------------------------------- TYPE OF REPORTING PERSON* 14 CO - -------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! SCHEDULE 13D CUSIP NO. 349 851 105 Page 3 of 6 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 9,427,791 Units - -------------------------------------------------------------------------- CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN 12 SHARES* ( ) - ------------------------------------------------------------------------- PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 13 61.7% - -------------------------------------------------------------------------- TYPE OF REPORTING PERSON* 14 CO - -------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! This Amendment No. 5 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 October 12, 1994, FGI purchased 791,000 Units in a privately negotiated transaction for an aggregate purchase price of $2,373,000, or $3.00 per Unit (such purchase being hereinafter referred to as the "October 12 Purchase"). The funds required by FGI to pay the purchase price for the Units purchased by it in the October 12 Purchase were obtained from FGI's existing cash balances. Item 4. Purpose of Transaction. Item 4 is hereby amended by adding the following at the end thereof: FGI's principal purpose in consummating the October 12 Purchase was to increase its equity interest in the Partnership. 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 October 12 Purchase, (i) FGI directly owned 4,921,980 Units, constituting 32.2% 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, 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 in Item 6 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. 4 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: October 13, 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. 5 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: October 13, 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. 6 -----END PRIVACY-ENHANCED MESSAGE-----