-----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, HiZ9BaOYURE+JVKWREyDXkIDNfo+Ui/XIFqPti4ehiLbqPu6xIGOxro12bHyatLW T6j9Pq62DcbttN0zIBWk7A== 0000877860-03-000009.txt : 20030128 0000877860-03-000009.hdr.sgml : 20030128 20030128151205 ACCESSION NUMBER: 0000877860-03-000009 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030128 FILED AS OF DATE: 20030128 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: NATIONAL HEALTH INVESTORS INC CENTRAL INDEX KEY: 0000877860 STANDARD INDUSTRIAL CLASSIFICATION: REAL ESTATE INVESTMENT TRUSTS [6798] IRS NUMBER: 621470956 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-10822 FILM NUMBER: 03527765 BUSINESS ADDRESS: STREET 1: 100 VINE ST STE 1400 STREET 2: CITY CENTER CITY: MURFREESBORO STATE: TN ZIP: 37130 BUSINESS PHONE: 6158909100 MAIL ADDRESS: STREET 1: P.O. BOX 1102 CITY: MURFREESBORO STATE: TN ZIP: 37133 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: LAROCHE RICHARD F JR CENTRAL INDEX KEY: 0001012859 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] RELATIONSHIP: DIRECTOR STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: P.O. BOX 1398 CITY: MURFREESBORO STATE: TN ZIP: 37133-1398 BUSINESS PHONE: 6158902020 MAIL ADDRESS: STREET 1: P.O. BOX 1398 CITY: MURFREESBORO STATE: TN ZIP: 37133-1398 4 1 edgar.txt FORM 4 - JANUARY 28, 2003 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person LaRoche, Jr., Richard F. 2103 Shannon Drive Murfreesboro, TN 37129 2. Issuer Name and Ticker or Trading Symbol National Health Investors, Inc. NHI 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year January 28, 2003 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Secretary 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 Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | | Transaction | or Disposed of (D) | Securities |ect | Beneficial Ownership | | | | | Beneficially |(D)or | | | | | | | A/| | Owned at |Indir | | | Date |Code|V| Amount | D | Price | End of Month |ect(I)| | ___________________________________________________________________________________________________________________________________| Common Stock by Trustee of | | | | | | |25,363 |I |Trustee | LaRoche Charitable Lead Tru| | | | | | | | | | st II | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock by LaRoche Fam| | | | | | |29,535 |I |Family Partnership | ily L.P. | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock by Trustee of | | | | | | |32,951 |I |Trustee | G.R.A.T. | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock by Shannon Ass| | | | | | |352,863 |D | | ociates | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock by LaRoche Ent| | | | | | |85,156 |D | | erprises | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock by IRA |1-28-0|P | |6,186 |A |$14.00 |8,208 |D | | |3 | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Common Stock in my name and|1-28-0|P | |900 |A |$14.00 |900 |D | | my wife's name |3 | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Con- |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of| Security |version |Transaction | rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | |or Exer | | | rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership | |Price of| | | posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva- | | | |Date |Expir| | |ficially |Ind| | |tive | | | | A/|Exer-|ation| Title and Number | |Owned at |ire| | |Secu- | | | | | D |cisa-|Date | of Shares | |End of |ct | | |rity |Date |Code|V| Amount | |ble | | | |Month |(I)| | ___________________________________________________________________________________________________________________________________| Option for Shares (R. |$14.50 | | | | | |10/99|10/26|Common Stock|20,000 |$14.50 |20,000 |D` | | LaRoche, Jr.) | | | | | | | |/05 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | ___________________________________________________________________________________________________________________________________|
Explanation of Responses: SIGNATURE OF REPORTING PERSON s/Richard F. LaRoche, Jr. DATE January 28, 2003 -----END PRIVACY-ENHANCED MESSAGE-----