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Previous: LEXINGTON HEALTHCARE GROUP INC, SC 13D, 1998-05-14 |
Next: LEXINGTON HEALTHCARE GROUP INC, 3, 1998-05-14 |
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FORM 3
U. S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility
Holding Company Act of 1935 or 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 4. Issuer Name AND Ticker or Trading Symbol
Requiring Lexington Healthcare Group, Inc. (LEXI)
Dermer Harry Statement
(Last) (First) (Middle) (Month/Day/Year)
5/14/97
3.IRS Identification 5. Relationship of Reporting 6. If Amendment,
Number of Person(s) to Issuer Date of Original
725 Town Hill Road Reporting Person, (Check all applicable) (Month/Day/Year)
(Street) if an entity _X__ Director __X_ 10% Owner
(Voluntary) _X__ Officer (give ____ Other (specify
title below) below)
New Hartford CT 06057 President and COO
(City) (State) (Zip) ------------------------- 7. Individual or
Joint/Group Filing
(Check Applicable
Line)
_X_Form filed by One
Reporting Person
___Form filed by
More than One
Reporting Person
TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
1. Title of Security 2. Amount of 3. Ownership Form: Direct (D) or 4.Nature of
(Instr. 4) Securities Indirect (I) Indirect
Beneficially (Instr. 5) Benficial
Owned Ownership
(Instr. 4) (Instr. 5)
Common Stock 615,500 D
* If the form is filed by more than one reporting person, see Instruction 5(b)(v).
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
(Over)
(Print or Type Responses)
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FORM 3 (continued)
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security 2.Date Exer- 3.Title and Amount of Securities 4.Conver- 5.Owner- 6.Nature of
(Instr. 4) cisable Underlying Derivative Security sion or ship Indirect
and (Instr. 4) Exercise Form of Beneficial
Expiration Price Deriv- Ownership
Date of ative (Instr. 5)
(Month/Day/ Deri- Security:
Year) vative Direct
Date Expira- Amount Security (D) or
Exer- tion Title or Indirect
cisable Date Number (I)
of (Instr. 5)
Shares
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Explanation of Responses:
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<S> <C> <C>
/s/ Harry Dermer 5/13/98
** 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).
Note: File three copies of this Form, one of which must be manually
signed. If space is insufficient, see Instruction 6 for procedure.
Page 2
(Print or Type Responses)
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