-----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, U9ZdhybDiaW8AGA16DT+ImSh8Rt367/bQ6iZ3YH2uVPd3NpFiIt/bfl7Zvi4GWY/ ypQoaQm1HXCHD8ZXzXlgTg== 0001095811-00-001290.txt : 20000510 0001095811-00-001290.hdr.sgml : 20000510 ACCESSION NUMBER: 0001095811-00-001290 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000430 FILED AS OF DATE: 20000509 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: 622369 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: PASQUALE DOUGLAS M CENTRAL INDEX KEY: 0001070021 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 245 FISHER AVE STE D-1 CITY: COSTA MESA STATE: CA ZIP: 92626 BUSINESS PHONE: 7147517400 MAIL ADDRESS: STREET 1: 245 FICHER AVE STE D-1 CITY: COSTA MESA STATE: CA ZIP: 92626 4 1 FORM 4 1 - ------ U.S. SECURITIES AND EXCHANGE COMMISSION ------------------------------ FORM 4 WASHINGTON, DC 20549 OMB APPROVAL - ------ ------------------------------ STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0287 [ ] Check this box if no Expires: December 31, 2001 longer subject to Filed pursuant to Section 16(a) of the Securities Estimated average burden Section 16. Form 4 Exchange Act of 1934, Section 17(a) of the hours per response.........0.5 or Form 5 obligations Public Utility Holding Company Act of 1935 ------------------------------ may continue. See or Section 30(f) of the Investment Company Instruction 1(b). Act of 1940 (Print or Type Response) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) PASQUALE DOUGLAS M. ARV ASSISTED LIVING, INC. (SRS) to Issuer (Check all applicable) - -------------------------------------------- ---------------------------------------------- X Director 10% Owner (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- --- 245 FISCHER AVENUE, SUITE D-1 Number of Reporting Month/Year Officer Other (specify - -------------------------------------------- Person (Voluntary) APRIL, 2000 ---- --- below) (Street) ------------------- (give title below) COSTA MESA CALIFORNIA 92626 5. If Amendment, PRESIDENT AND CHIEF EXECUTIVE OFFICER - -------------------------------------------- Date of Original ------------------------------------- (City) (State) (Zip) (Month/Year) 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. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action action or Disposed of (D) Securities Form: Indirect Date Code (Instr. 3, 4 and 5) Beneficially Direct Beneficial (Instr. 8) Owned at (D) or Ownership (Month/ End of Month Indirect (Instr. 4) Day/ --------------------------------------- (Instr. 3 and 4) (I) Year) Code V Amount (A) or Price (Instr. 4) (D) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 04/25/00 P 7,500 A $1.125 9,800 D - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 04/25/00 P 300 A $1.00 9,800 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ REMINDER: REPORT ON A SEPARATE LINE FOR EACH CLASS OF SECURITIES BENEFICIALLY OWNED DIRECTLY OR INDIRECTLY. (Over) *IF THE FORM IS FILED BY MORE THAN ONE REPORTING PERSON, SEE INSTRUCTION 4(b)(v). SEC 1474 (3/99)
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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 Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv- Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative Deriv- Day/ Disposed of (D) (Month/Day/ Secur- ative Year) (Instr. 3, 4, Year) ity Security and 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Code V (A) (D) Date Expira- Title Amount or Exer- tion Number of cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 9. Number of 10. Ownership 11. Nature of Derivative Form of Indirect Securities Derivative Beneficial Beneficially Security: Ownership Owned at End Direct (D) (Instr. 4) of Month or Indirect (I) (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). /s/ DOUGLAS M. PASQUALE May 3, 2000 Note: File three copies of this Form, one of which must be manually signed. ------------------------------- --------------- If space provided is insufficient, see Instruction 6 for procedure. **Signature of Reporting Person Date Douglas M. Pasquale Potential persons who are to respond to the collection of information Page 2 of 2 contained in this form are not required to respond unless the form SEC 1474 (7/96) displays a currently valid OMB Number.
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