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- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION -----------------------------
FORM 3 WASHINGTON, D.C. 20549 OMB APPROVAL
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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, Estimated average burden
Section 17(a) of the Public Utility Holding Company Act of 1935 or hours per response .... 0.5
(Print or Type Responses) Section 30(f) of the Investment Company Act of 1940 -----------------------------
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1. Name and Address of Reporting Person* 2. Date of Event Re- 4. Issuer Name AND Ticker or Trading Symbol
quiring Statement
LTC Healthcare, Inc. (Month/Day/Year) Regent Assisted Living, Inc. (RGNT)
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(Last) (First) (Middle) March 26, 1998 5. Relationship of Reporting Person(s) 6. If Amendment, Date
----------------------- to Issuer (Check all applicable) of Original
3. IRS Identification Director X 10% Owner (Month/Day/Year)
Number of Reporting ---- ---- March 26, 1998
300 Esplanade Drive, Suite 1860 Person, if an entity Officer (give Other (specify --------------------
- ------------------------------------------------- (Voluntary) title below) below) 7. Individual or
(Street) ---- ---- Joint/Group Filing
91-1895305 (Check Applicable
Line)
--------------------------- Form filed by One
X Reporting Person
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Form filed by
More than One
Reporting Person
Oxnard, California 93030 ---
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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
(Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5)
(Instr. 4) (D) or Indirect
(I) (Instr. 5)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Page 1 of 2)
* If the form is filed by more than one Reporting Person, SEE Instruction 5(b)(v). SEC 1473 (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 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE
SECURITIES)
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1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial
Expiration (Instr. 4) Exercise Form of Ownership
Date Price of Deriv- (Instr. 5)
(Month/Day/ Deri- ative
Year) vative Security:
-------------------------------------------------- Security Direct
Amount (D) or
Date Expir- or Indirect
Exer- ation Title Number (I)
cisable Date of
Shares (Instr. 5)
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Put Option re: 7.5% Convertible Imme- March 7.5% Convertible $10 million* $10 million* (D)
Subordinated Notes diately 31, Subordinated Notes Due
(Obligation to Buy)* 2000* March 31, 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 Federal **Signature of Reporting Person Date
Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Name: Pamela J. Privett
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 of 2
SEC 1473 (7-97)
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ATTACHMENT TO AMENDED FORM 3 FOR LTC HEALTHCARE, INC.
RELATING TO MARCH 26, 1998 REPORTABLE EVENT
*On March 26, 1998, LTC Healthcare, Inc. ("Healthcare") 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"). 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 of Regent ("Regent 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.
