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- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------------
FORM 4 WASHINGTON, D.C. 20549 OMB APPROVAL
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/ / CHECK THIS BOX IF NO STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0287
LONGER SUBJECT TO EXPIRES: SEPTEMBER 30, 1998
SECTION 16. FORM 4 OR Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN
FORM 5 OBLIGATIONS MAY Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 0.5
CONTINUE. SEE Section 30(f) of the Investment Company Act of 1940 ----------------------------
INSTRUCTION 1(b).
(Print or Type Responses)
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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)
Director X 10% Owner
LTC Healthcare, Inc. Regent Assisted Living, Inc. (RGNT) --- ---
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(Last) (First) (Middle) 3. IRS or Identification 4. Statement for --- title --- (specify
Number of Reporting Month/Year below) below
Person, if an entity ----------------- ----------------
300 Esplanade Drive, Suite 1860 (Voluntary) April 1998
- -------------------------------------------- --------------------- 7. Individual or Joint/Group Filing
(Street) 5. If Amendment, (Check Applicable Line)
91-1895305 Date of Original _X_Form filed by One Reporting Person
(Month/Year) ___Form filed by More than One
Oxnard, CA 93030 April 1998 Reporting Person
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(City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
(Instr. 3) action action or Disposed of (D) Securities ship of In-
Date Code (Instr. 3, 4 and 5) Beneficially Form: direct
(Instr. 8) Owned at Direct Bene-
(Month/ End of (D) or ficial
Day/ ------------------------------------------- Month Indirect Owner-
Year) (A) or (I) ship
Code V Amount (D) Price (Instr. 3 (Instr. 4) (Instr. 4)
and 4)
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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 (7-97)
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 CONTROL NUMBER.
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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)
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1. Title of Derivative Security 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- 6. Date Exer-
(Instr. 3) sion or action tion Code ative Securities Ac- cisable and Ex-
Exercise Date (Instr. 8) quired (A) or Dis- piration Date
Price of (Month/ posed of (D) (Month/Day/
Deriv- Day/ (Instr. 3, 4, and 5) Year)
ative Year)
Security
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Code V (A) (D) Date Expira-
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cisable Date
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Put Option re: 7.5% $1.0 million April 22, X $1.0 4/22/98 3/31/00
Convertible Subordinated (100% of face 1998 mill.
Notes (Obligation to Buy)* amount) ** princ.
amt. of
Notes
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7.5% Convertible $7.50 per April 22, X $1.0 4/22/98 3/31/08
Subordinated Notes Due share, 1998 million
March 31, 2008* subject to ** principal
adjustment amount of
Notes
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7. Title and Amount of Under- 8. Price 9. Number 10. Owner- 11. Nature
lying Securities of of Deriv- ship of In-
(Instr. 3 and 4) Deriv- ative Form direct
ative Securi- of De- Bene-
Secur- ties rivative ficial
ity Bene- Secu- Own-
(Instr. ficially rity: ership
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at End (D) or
Amount or of Indi-
Title Number of Month rect (I)
Shares (Instr. 4) (Instr. 4)
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7.5% 133,333 $1.0 Put Option D
Convertible million with respect
Subordinated to $5.0
Notes Due million
March 31, principal
2008 amount of
Notes
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Common 133,333 $1.0 $5.0 million D
Stock million principal
amount of
Notes
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Explanation of Responses:
See Attachment for Footnotes
LTC HEALTHCARE, INC.
By: /s/ Pamela J. Privett January 11, 1999
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**Intentional misstatements or omissions of facts constitute **Signature of Reporting Person Date
Federal Criminal Violations. SEE 18 U.S.C. 1001 and 15 Name: Pamela J. Privett
U.S.C. 78ff(a). Title: Senior Vice President,
General Counsel and
Secretary
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.
Page 2
SEC 1474 (7-97)
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ATTACHMENT TO AMENDED FORM 4 FOR LTC HEALTHCARE, INC.
RELATING TO APRIL 22, 1998 REPORTABLE EVENT
*On March 26, 1998, Healthcare and Regent executed a Convertible Subordinated
Note Purchase Agreement (the "Purchase Agreement"). The Purchase Agreement
established a put option pursuant to which Healthcare is obligated to purchase
from Regent, upon Regent's demand, up to $10,000,000 principal amount of
convertible subordinated notes due 2008 (the "Notes"). Regent must exercise
such put option on or prior to March 31, 2000. The Notes are convertible, in
whole or in part at any time prior to March 31, 2008 at Healthcare's option,
into Common Stock at a price of $7.50 per share, subject to adjustment. If
all Notes were converted, such conversion would result in the issuance of
1,333,333 shares of Regent Common Stock. Under certain circumstances, Regent
can require conversion of the Notes prior to March 31, 2008, at a price of
$7.50 per share, subject to adjustment.
**On April 22, 1998, Regent put $1,000,000 principal amount of Notes to
Healthcare. As a result, Healthcare purchased $1,000,000 principal amount of
Notes on such date for a purchase price of $1,000,000. Such $1,000,000
principal amount of Notes are convertible, at a price of $7.50 per share, into
133,333 shares of Common Stock.
