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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 September 1998 ----------------- ----------------
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(Street) 5. If Amendment, 7. Individual or Joint/Group Filing
Date of Original (Check Applicable Line)
(Month/Year) _X_Form filed by One Reporting Person
___Form filed by More than One
Oxnard, CA 93030 September 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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Common Stock, no par value per share 9/25/98 J* 69,000 A N/A 69,000 D
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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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Date Expira-
-------------------------------------- Exer- tion
cisable Date
Code V (A) (D)
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Put Option re: 7.5% $2.0 million September X $2.0 9/1/98 3/31/00
Convertible Subordinated (100% of face 1,1998 mill
Notes (Obligation to Buy)** amount) *** princ.
amt.
of
Notes
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7.5% Convertible $7.50 per September X $2.0 9/1/98 3/31/08
Subordinated Notes Due share, subject 1,1998 million
March 31, 2008** to adjustment *** principal
amount
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)
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Amount or of Indi-
Title Number of Month rect (I)
Shares (Instr. 4) (Instr. 4)
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7.5% 266,667 $2.0 million Put Option D
Convertible with respect to
Subordinated $1.5 million
Notes Due principal
March 31, amount of
2008 Notes
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Common 266,667 $2.0 million $8.5 million D
Stock 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 U.S.C. 78ff(a). Name: Pamela J. Privett
Title: Senior Vice President,
Note: File three copies of this Form, one of which must be manually signed. General Counsel and
If space is insufficient, SEE Instruction 6 for procedure. Secretary
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 SEPTEMBER 1, 1998 REPORTABLE EVENT
*On September 25, 1998, LTC Properties, Inc. ("Properties") contributed
69,000 shares of common stock ("Common Stock") of Regent Assisted Living,
Inc. ("Regent") to LTC Healthcare, Inc. ("Healthcare"), then a 99%-owned
subsidiary of Properties. Such shares were purchased by Properties in open
market transactions in February and March 1998. The contribution of such
shares by Properties to Healthcare was recorded by Healthcare as a
contribution to capital. Such contribution was neither a sale by Properties
nor a purchase by Healthcare under Section 16(b) of the Securities Exchange
Act of 1934, as amended (the"Act"), and, accordingly, such transaction is not
subject to Section 16(b) of the Act.
**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 September 1, 1998, Regent put $2,000,000 principal amount of Notes to
Healthcare. As a result, Healthcare purchased $2,000,000 principal amount of
Notes on such date for a purchase price of $2,000,000. Such $2,000,000
principal amount of Notes are convertible, at a price of $7.50 per share,
into 266,667 shares of Common Stock.