UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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1. Name and Address of Reporting Person
Health Partners
54 Thompson Street
New York, NY 10012
2. Date of Event Requiring Statement (Month/Day/Year)
5/14/99
3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
4. Issuer Name and Ticker or Trading Symbol
Brookdale Living Communities, Inc. (BLCI)
5. Relationship of Reporting Person to Issuer (Check all applicable)
[ ] Director [X] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
6. If Amendment, Date of Original (Month/Day/Year)
7. Individual or Joint/Group Filing (Check Applicable Line)
[ ] Form filed by One Reporting Person
[X] Form filed by More than One Reporting Person
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Table I Non-Derivative Securities Beneficially Owned
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1)Title of Security 2)Amount of 3) 4)Nature of
Securities D Indirect
Beneficially or Beneficial
Owned I Ownership
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<S> <C> <C> <C>
Common Stock, $.01 par value per share 5,479,452 (I) By direct ownership of 5 1/2%
Convertible Subordinated Notes
due 2009 (see Table II)
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Table II Derivative Securitites Beneficially Owned
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1)Title of Derivative Security 2)Date Exercisable 3)Title and Amount of 4)Conver- 5)Ownership 6)Nature of
and Expiration Date Securities Underlying sion or Form of Indirect
(Month/Day/Year) Derivative Security exercise Derivative Beneficial
price of Security Ownership
Date Expira- Amount or Deri- Direct(D)
Exer- tion Number of vative or
cisable Date Title Shares Security Indirect(I)
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<S> <C> <C> <C> <C> <C> <C> <C>
5 1/2 % Convertible
Subordinated Notes due 2009 5/14/99 5/14/09 Common Stock, $.01 5,479,452 $18.25 (D) N/A
par value per share
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Explanation of Responses:
None.
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<TABLE>
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HEALTH PARTNERS
** Intentional misstatements or omissions of facts constitute
Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C.
78ff(a). By: Capital Z Financial Services Fund II, L.P., its
general partner
Note: File three copies of this Form, one of which must be
manually signed. If space is insufficient, See Instruction
6 for procedure. By: Capital Z Partners, L.P., its general partner
Potential persons who are to respond to the collection of
information contained in this form are not required to By: Capital Z Partners, Ltd., its general partner
respond unless the form displays a currently valid OMB Number.
By: /s/ David A. Spuria
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David A. Spuria November 19, 1999
General Counsel,
Vice President of
Administration and
Secretary
**Signature of Reporting Person
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Other Filing Parties Pursuant to Instruction 5(b)(v)
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Capital Z Financial Services Fund II, L.P. Capital Z Financial Services Fund II, L.P.
54 Thompson Street
New York, New York 10012 By: Capital Z Partners, L.P., its general partner
Indirect beneficial owner solely in its capacity as general partner of
Health Partners. Capital Z Financial Services Fund II, L.P. disclaims By: Capital Z Partners, Ltd., its general partner
beneficial ownership of the securities held by Health Partners to the
extent of its pecuniary interest therein.
By: /s/ David A. Spuria
---------------------------------------------
David A. Spuria November 19, 1999
General Counsel,
Vice President of
Administration and
Secretary
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Capital Z Partners, L.P. Capital Z Partners, L.P.
54 Thompson Street
New York, New York 10012 By: Capital Z Partners, Ltd., its general partner
Indirect beneficial owner solely in its capacity as the sole general
partner of Capital Z Financial Services Fund II, L.P. Capital Z
Partners, L.P. disclaims beneficial ownership of the securities held By: /s/ David A. Spuria
by Health Partners to the extent of its pecuniary interest therein. -------------------------------------------
David A. Spuria November 19, 1999
General Counsel,
Vice President of
Administration and
Secretary
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Capital Z Partners, Ltd. Capital Z Partners, Ltd.
54 Thompson Street
New York, New York 10012
Indirect beneficial owner solely in its capacity as the sole general By: /s/ David A. Spuria
partner of Capital Z Partners, L.P. Capital Z Partners, Ltd. disclaims -------------------------------------------
beneficial ownership of the securities held by Health Partners to the David A. Spuria November 19, 1999
extent of its pecuniary interest therein. General Counsel,
Vice President of
Administration and
Secretary
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Steven M. Gluckstern, who is the Chairman of the Board of Capital Z
Partners, Ltd., and Robert A. Spass, who is the Deputy Chairman of the Board of
Capital Z Partners, Ltd., may be deemed to be beneficial owners of the
securities held by Health Partners. Messrs. Gluckstern and Spass disclaim any
such beneficial ownership.
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