-----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, AxZMS6WGsUT1OMQwCD8lcGN4y3itnmzOxc/0xVXS70vRE2uz12RLzGjJWrH5x5hj 4w3vo2swnge82hFsu480tA== 0001095811-00-001361.txt : 20000512 0001095811-00-001361.hdr.sgml : 20000512 ACCESSION NUMBER: 0001095811-00-001361 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000503 FILED AS OF DATE: 20000511 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: 626748 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 Instruction 1(b). 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 applicable) PASQUALE DOUGLAS M. ARV ASSISTED LIVING, INC. (SRS) X Director 10% Owner - --------------------------------------------- ---------------------------------------------- --- --- (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for Officer Other Number of Reporting Month/Year --- --- 245 FISCHER AVENUE, SUITE D-1 Person (Voluntary) MAY 2000 (give title (Specify title - --------------------------------------------- ------------------- below) below) (Street) 5. If Amendment, PRESIDENT AND CHIEF EXECUTIVE Date of OFFICER COSTA MESA CA 92626 Original -------------------------------- - --------------------------------------------- (Month/Year) 7. Individual or Joint/Group Filing (City) (State) (Zip) (Check Applicable Line) ------------------ X Form filed by one Reporting --- Person Form filed by more than --- one Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- 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 (D) Beneficial (Instr. 8) Owned at or Ownership ---------- -------------- ------------------------- End of Month Indirect (I) (Instr. 4) (Month/ (Instr. 3 and 4) (Instr. 4) Day/ Year) - ------------------------------------------------------------------------------------------------------------------------------------ (A) or Code V Amount (D) Price - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 05/03/00 P 4,700 A $1.00 14,500 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. Transaction 5. Number of 6. Date Exer- 7. Title and 8. Price of Security sion or action Code Derivative cisable and Amount of Derivative (Instr. 3) Exercise Date (Instr. 8) Securities Expiration Underlying Security Price of (Month/ Acquired (A) Date Securities (Instr. 5) Derivative Day/ or Disposed of (Month/Day/ (Instr. Security Year) (D) (Instr. 3, Year) 3 and 4) 4, and 5) - ------------------------------------------------------------------------------------------------------------------------------------ Date Expira- Amount or Exer- tion Number of cisable Date Title Shares - ------------------------------------------------------------------------------------------------------------------------------------ Code V (A) (D) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------- 1. Title of Derivative 9. Number of 10. Ownership 11. Nature of Security Derivative Form of Indirect (Instr. 3) 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 /s/ DOUGLAS M. PASQUALE MAY 8, 2000 Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). -------------------------- ---------------- Douglas M. Pasquale Date **Signature of Reporting Person Note: File three copies of this Form, one of which must be manually signed. Page 2 If space is insufficient, see Instruction 6 for procedure. SEC 1474 (3-99) 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.
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