<PAGE>
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G
(RULE 13D-102)
INFORMATION STATEMENT PURSUANT TO RULES 13-D AND 13D-2
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(AMENDMENT NO. ______________)<F1>
ALTERNATIVE LIVING SERVICES, INC.
(Name of Issuer)
COMMON STOCK, $.01 PAR VALUE PER SHARE
(Title of Class of Securities)
02145K-10-7
(CUSIP Number)
<F1> The remainder of this cover page shall be filled out for a reporting
person's initial filing on this form with respect to the subject class of
securities, and for any subsequent amendment containing information which
would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be
deemed to be "filed" for the purpose of Section 18 of the Securities
Exchange Act of 1934 or otherwise subject to the liabilities of that
section of the Act but shall be subject to all other provisions of the Act
(however, see the Notes).
Page 1 of 4 pages
<PAGE>
CUSIP No. 02145K-10-7 13G Page 2 of 4 Pages
- ---------------------------------------------------------------------------
(1) Names of Reporting Persons
S.S. or I.R.S. Identification No. of Above Persons
Jerry L. Tubergen
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(2) Check the Appropriate Box if a Member of a Group*
(a) [ ]
(b) [ X ]
- ---------------------------------------------------------------------------
(3) SEC Use Only
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(4) Citizenship or Place of Organization
USA
- ---------------------------------------------------------------------------
Number of (5) Sole Voting Power 246,919
Shares ----------------------------------------------------
Beneficially
Owned by (6) Shared Voting Power 415,532
Each ----------------------------------------------------
Reporting
Person (7) Sole Dispositive Power 246,919
With ----------------------------------------------------
(8) Shared Dispositive Power 415,532
- ---------------------------------------------------------------------------
(9) Aggregate Amount Beneficially Owned by Each Reporting Person
662,451
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(10) Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares*
[ ]
- ---------------------------------------------------------------------------
(11) Percent of Class Represented by Amount in Row 9
5.11%
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<PAGE>
(12) Type of Reporting Person*
IN
- ---------------------------------------------------------------------------
*SEE INSTRUCTIONS BEFORE FILLING OUT!
<PAGE>
Securities and Exchange Commission
Schedule 13G
Page 3 of 4 pages
ITEM 1(A). NAME OF ISSUER:
Alternative Living Services, Inc.
ITEM 1(B). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES:
450 N. Sunnyslope Road, Suite 300
Brookfield, Wisconsin 53005
ITEM 2(A). NAME OF PERSON FILING:
Jerry L. Tubergen
ITEM 2(B). ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE:
126 Ottawa Avenue, Suite 500
Grand Rapids, Michigan 49503
ITEM 2(C). CITIZENSHIP:
United States of America
ITEM 2(D). TITLE OF CLASS OF SECURITIES:
Common Stock, $.01 par value per share
ITEM 2(E). CUSIP NUMBER:
02145K-10-7
ITEM 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D-1(B), OR
13D-2(B), CHECK WHETHER THE PERSON FILING IS A:
Not applicable.
(a) [ ] Broker or dealer registered under Section 15 of the
Act,
(b) [ ] Bank as defined in Section 3(a)(6) of the Act,
(c) [ ] Insurance Company as defined in Section 3(a)(19) of
the Act,
(d) [ ] Investment Company registered under Section 8 of
the Investment Company Act,
<PAGE>
Securities and Exchange Commission
Schedule 13G
Page 3 of 4 pages
(e) [ ] Investment Adviser registered under Section 203 of
the Investment Advisers Act of 1940,
(f) [ ] Employee Benefit Plan, Pension Fund which is
subject to the provisions of the Employee
Retirement Income Security Act of 1974 or Endowment
Fund; SEE 13d-1(b)(1)(ii)(F),
(g) [ ] Parent Holding Company, in accordance with Rule
13d-1(b)(ii)(G); SEE Item 7,
(h) [ ] Group, in accordance with Rule 13d-1(b)(1)(ii)(H).
<PAGE>
Securities and Exchange Commission
Schedule 13G
Page 4 of 4 pages
ITEM 4. OWNERSHIP.
(a) Amount Beneficially Owned: 662,451 shares
(b) Percent of Class: 5.11%
(c) Number of shares as to which such person has:
(i) Sole power to vote or to direct
the vote 246,919 shares
(ii) Shared power to vote or to
direct the vote 415,532 shares
(iii) Sole power to dispose or to
direct the disposition of 246,919 shares
(iv) Shared power to dispose or to
direct the disposition of 415,532 shares
ITEM 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS.
Not Applicable
ITEM 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER
PERSON.
The Reporting Person (i) holds the sole voting and
dispositive power relating to 246,919 shares of Common Stock
that he beneficially owns in his name (which number includes
7,745 shares which he may acquire pursuant to options
exercisable in the next 60 days) and (ii) shares voting and
dispositive power relating to 415,532 shares of Common Stock
that he may be deemed to beneficially own as co-trustee of
four trusts (103,883 shares are beneficially owned for each
trust).
ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH
ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT
HOLDING COMPANY.
Not Applicable
ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP.
Not Applicable
<PAGE>
Securities and Exchange Commission
Schedule 13G
Page 4 of 4 pages
ITEM 9. NOTICE OF DISSOLUTION OF GROUP.
Not Applicable
ITEM 10. CERTIFICATION.
Not Applicable
SIGNATURE
After reasonable inquiry and to the best of my
knowledge and belief, I certify that the information
set forth in this statement is true, complete and
correct.
February 13, 1997
Date
/S/ JERRY L. TUBERGEN
Signature
Jerry L. Tubergen
