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FORM 3 OMB APPROVAL
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OMB Number: 3235-0104
Expires: September 30, 1998
Estimated average burden
hours per response 0.5
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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
(Print or Type Responses)
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1. Name and Address of Reporting Person*
Schramm Carl J.
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(Last) (First) (Middle)
c/o OptiCare Health Systems, Inc.
87 Grandview Ave.
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(Street)
Waterbury, CT 06708
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
01/20/00
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3. IRS Identification Number of Reporting Person if an entity (voluntary)
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4. Issuer Name and Ticker or Trading Symbol
OptiCare Health Systems, Inc. (OPT)
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director
[ ] 10% Owner
[ ] Officer (give title below)
[ ] Other (specify below)
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6. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint/Group Filing
(Check Applicable Line)
[X] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
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SEC 1473 (7/96)
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FORM 3 (continued)
<TABLE>
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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 Onwership
(Instr. 4) Beneficially Owned Form: Direct (Instr. 5)
(Instr. 4) (D) or Indirect
(I) (Instr. 5)
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<S> <C> <C> <C>
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If the form is filed by more than one reporting person, see
Instruction 5(b)(v).
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SEC 1473 (7/96)
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FORM 3 (CONTINUED)
<TABLE>
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TABLE II--DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of
Security (Instr. 4) cisable and Underlying Derivative Security sion or ship Indirect
Expiration (Instr. 4) Exercise Form of Beneficial
Date ----------------------------------- Price of Deriv- Ownership
(Month/Day/Year) Deriv- ative (Instr. 5)
--------------------- Amount ative Security
or Security Direct
Date Expira- Title Number (D) or
Exer- tion of Indirect
cisable Date Shares (I)
(Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
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Stock Option 1/20/01 1/20/10 Common Stock 3,334 3.875 D
(right to buy)
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Stock Option 1/20/02 1/20/10 Common Stock 3,333 3.875 D
(right to buy)
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Stock Option 1/20/03 1/20/10 Common Stock 3,333 3.875 D
(right to buy)
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</TABLE>
Explanation of Responses:
/s/ Carl J. Schramm 1/26/00
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** Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute 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 provided is insufficient, see Instruction 6 for procedure.
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SEC 1473 (7/96)
