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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 Identification 4. Statement for --- title --- (specify
Number of Reporting Month/Year below) below
Person, if an entity
(Voluntary) ----------------- ----------------
300 Esplanade Drive, Suite 1860 November 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 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 cisable and
Exercise Date (Instr. 8) Acquired (A) or Expiration Date
Price of (Month/ Disposed of (D) (Month/Day/Year)
Deriv- Day/ (Instr. 3, 4, and 5)
ative Year)
Security
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Code V (A) (D) Date Expira-
Exer- tion
cisable Date
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Put Option re: 7.5% $1.5 million November E $1.5 Immed. 3/31/00
Convertible Subordinated (100% of face 30, 1998 mill.
Notes (Obligation to Buy)* amount) princ.
amt. 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
- -------------------------------- 5) Owned Direct (Instr. 4)
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% 200,000 $8.5 million D
Convertible principal
Notes Due amount of
March 31, Notes
2008
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Explanation of Responses:
See Attachment for Footnote
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 FORM 4 FOR LTC HEALTHCARE, INC.
RELATING TO NOVEMBER 30, 1998 REPORTABLE EVENT
*On March 26, 1998, LTC Healthcare, Inc. and Regent Assisted Living, Inc.
("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"). In four transactions from March
through September 1998, Regent put $8,500,000 principal amount of Notes to
Healthcare. Effective November 30, 1998, Healthcare and Regent entered into
an amendment to the Purchase Agreement whereby Healthcare is not obligated to
purchase any additional Notes.
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 1,133,333 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.
