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FORM 3
- ------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------
WASHINGTON, D.C. 20549 OMB APPROVAL
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES OMB NUMBER 3235-0104
EXPIRES: SEPTEMBER 30, 1998
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section ESTIMATED AVERAGE BURDEN
17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) HOURS PER RESPONSE 0.5
of the Investment Company Act of 1940 ------------------------------
(Print or Type Responses)
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1. Name and Address of Reporting 2. Date of Event 4. Issuer Name and Ticker or Trading Symbol
Person* Requiring Statement
(Month/Day/Year) Regent Assisted Living, Inc. (RGNT)
LTC Healthcare, Inc. March 26, 1998
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3. I.R.S. 5. Relationship of Reporting Person(s) 6. If Amendment, Date of
Identification to Issuer Original
Number of (Check all applicable) (Month/Day/Year)
Reporting Person,
if an entity Director X 10% Owner
300 Esplanade Drive, Suite 1860 (voluntary) ------ ------ -----------------------------
- ------------------------------------ Officer Other 7. Individual or
(Street) ------ ------- Joint/Group Filing
91-1895305 (give title below) (specify below) (Check Applicable Line)
X Form filed by One
----------------------------------- --- Reporting Person
--- Form filed by More
Oxnard, California 93030 than One Reporting Person
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(City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial Ownership
(Instr. 4) Beneficially Owned Form: (Instr. 5)
(Instr. 4) Direct (D) or
Indirect (I)
(Instr. 5)
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Reminder: Report on a separate line for each class of securities (PAGE 1 of 2)
beneficially owned directly or indirectly. SEC 1473 (7/97)
*If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v)
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Potential persons who are to respond to the collection of inforamtion
contained in this form are not required to respond unless
the form displays a currently valid OMB control number
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS,
CONVERTIBLE SECURITIES)
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1. Title of 2. Date Exercisable and 3. Title and Amount 4. Conversion 5. Ownership Form 6. Nature of
Derivative Expiration Date of Securities or Exercise of Derivative Indirect
Security (Month/Day/Year) Underlying Price of Security: Direct Beneficial
(Instr. 4) Derivative Security Derivative (D) or Indirect (I) Ownership
(Instr. 4) Security (Instr. 5) (Instr. 5)
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Date Expiration Amount or Number
Exercisable Date Title of Shares
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7.5% Convertible March 30, March 31, Common Stock, 533,333* $7.50, subject (D)
Subordinated Notes Due 1998 2008 no par value to adjustment
March 31, 2008 (the "Notes")
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Explanation of Responses:
* Regent Assisted Living, Inc. has an option to require LTC Healthcare,
Inc. to purchase up to an additional $6 million principal amount of Notes
(convertible into up to 800,000 additional shares of Common Stock at a
conversion price of $7.50 per share, subject to adjustment). Such option
must be exercised on or prior to March 31, 2000.
** 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 provided 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.
LTC HEALTHCARE, INC.
By: /s/ Pamela J. Privett April 6, 1998
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**Signature of Reporting Person Date
Name: Pamela J. Privett
Title: Senior Vice President, General Counsel and Secretary
(Page 2 of 2)
