-----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, Jg7RlwpGMEtx10BvtBQCbaoU09awc9I0fbiRUn1kiiO6G6NLGXI4K18gHrE/tlEd NlKJyVWS+2B7quF5zbqpFg== 0000892569-98-003231.txt : 19981203 0000892569-98-003231.hdr.sgml : 19981203 ACCESSION NUMBER: 0000892569-98-003231 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981130 FILED AS OF DATE: 19981202 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ARV ASSISTED LIVING INC CENTRAL INDEX KEY: 0000949322 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-NURSING & PERSONAL CARE FACILITIES [8050] IRS NUMBER: 330160968 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-26980 FILM NUMBER: 98762922 BUSINESS ADDRESS: STREET 1: 245 FISCHER AVE STREET 2: SUITE D-1 CITY: COSTA MESA STATE: CA ZIP: 92626 BUSINESS PHONE: 7147517400 MAIL ADDRESS: STREET 1: 245 FISCHER AVENUE STREET 2: SUITE D-1 CITY: COSTA MESA STATE: CA ZIP: 92626 COMPANY DATA: COMPANY CONFORMED NAME: BOOTY JOHN A CENTRAL INDEX KEY: 0001073159 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O ARV ASSISTED LIVING INC STREET 2: 245 FISCHER AVE SUITE D-1 CITY: COSTA MESA STATE: CA ZIP: 92626 BUSINESS PHONE: 7147517400 MAIL ADDRESS: STREET 1: C/O ARV ASSISTED LIVING INC STREET 2: 245 FISCHER AVE SUITE D-1 CITY: COSTA MESA STATE: CA ZIP: 92626 4 1 FORM 4 FOR JOHN A. BOOTY 1
- ------ --------------------------- FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL - ------ WASHINGTON, D.C. 20549 --------------------------- STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0287 EXPIRES: SEPTEMBER 30, 1998 ESTIMATED AVERAGE BURDEN HOURS PER RESPONSE............... 0.5 --------------------------- [ ] CHECK THIS BOX IF NO LONGER SUBJECT TO SECTION 16. FORM 4 OR FORM 5 OBLIGATIONS MAY CONTINUE. SEE INSTRUCTION 1(B). 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 (Print or Type Responses) - ----------------------------------------- ------------------------------------------- ------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all Booty John A. ARV ASSISTED LIVING, INC. (SRS) applicable) - --------------------------------------------------------------------------------------- (Last) (First) (Middle) X Director __ 10% Owner __ Officer (give title below) 245 Fischer Avenue, Suite D-1 __ Other - ----------------------------------------- (specify below) (Street) Costa Mesa CA 92626 3. IRS or Social Security 4. Statement - ----------------------------------------- Number of Reporting for (City) (State) (Zip) Person (Voluntary) Month/Year 11/98 5. If Amendment, 7. Individual or Joint/Group Filing Date of Original (Check Applicable Line) (Month/Year) 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. Transaction 3. Transaction 4. Securities Acquired 5. Amount 6. Ownership 7. Nature (Instr. 3) Date Code (A) or Disposed of (D) of Form: of (Instr. 8) (Instr. 3, 4 and 5) Securities Direct (D) Indirect Beneficially or Beneficial Owned Indirect Ownership at End (I) of Month (Instr. 4) (Instr. 4.) ------------------------------------------------------------ (Instr. 3 (Month/Day/Year) Code V Amount (A) or (D) Price and 4) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 11/2/98 G V 5,000 D N/A 364,028 I Trust - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 4(b)(v). (Over) SEC 1474 (7-96) 2 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. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and 8. Price Derivative sion or action action Deriv- cisable Amount of of Security (Instr. 3) Exercise Date Code ative and Underlying Derivative Price of (Month/ (Instr. 8) Securities Expiration Securities Security Derivative Day/ Acquired Date (Instr. 3 and (Instr. 5) Security Year) (A) or (Month/Day/Year) 4) Disposed of (D) (Instr. 3, 4, and 5) ----------------------------------------------------------- Code V (A) (D) Date Expira- Title Amount Exer- tion Date or cisable Number of Shares - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------ 9. Number 10. Ownership 11. Nature of of Form of Indirect Derivative Derivative Beneficial Securities Security; Ownership Beneficially Direct (Instr. 4) Owned (D) or at End of Indirect (I) Month (Instr. 4) (Instr. 4) - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - --------------------------------------------------------------------------------
EXPLANATION OF RESPONSES: ** 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 IS INSUFFICIENT, SEE INSTRUCTION 6 FOR PROCEDURE. POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTION OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB NUMBER. /s/ SHEILA M. MULDOON DECEMBER 2, 1998 - ---------------------------------- ---------------- ** SIGNATURE OF REPORTING PERSON DATE JOHN A. BOOTY, BY SHEILA M. MULDOON, HIS ATTORNEY IN FACT -----END PRIVACY-ENHANCED MESSAGE-----