<PAGE> 1
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
FORM 10-C
REPORT BY ISSUER OF SECURITIES QUOTED ON NASDAQ
INTER-DEALER QUOTATION SYSTEM FILED PURSUANT TO
SECTION 13 OF 15(d) OF THE SECURITIES EXCHANGE ACT
OF 1934 AND RULES 13a-17 AND 15d-17 THEREUNDER
Princeton Dental Management Corporation
- --------------------------------------------------------------------------------
(Exact Name of Issuer as Specified in Charter)
7421 West 100th Place, Bridgeview, IL 60455
- --------------------------------------------------------------------------------
(Address of Principal Executive Offices)
(708) 974-4000
- --------------------------------------------------------------------------------
(Issuer's Telephone Number, Including Area Code)
I. CHANGE IN NUMBER OF SHARES OUTSTANDING
Indicate any change (Increase or Decrease) of five percent or more in the
number of shares outstanding:
1. Title of security Common Stock
-----------------------------------------------------------
2. Number of shares outstanding before the change 8,169,870
------------------------------
3. Number of shares outstanding after the change 10,263,657
------------------------------
4. Effective date of change August 9, 1996 (Subject to pending issuance of
----------------------------------------------------
certificates)
-------------------------------------------------------------------------------
5. Method of change:
Specify method (such as merger, acquisition, exchange, distribution, stock
split, reverse split, acquisition of stock to treasury, etc.)
Conversion of convertible debt to equity
------------------------------------------------------------------------------
Give brief description of transaction Conversion of debt to equity under a
-----------------------------------------
certain convertible debt agreement
-------------------------------------------------------------------------------
II. CHANGE IN NAME OF ISSUER
1. Name prior to change
-------------------------------------------------------
2. Name after change
-------------------------------------------------------
3. Effective date of charter amendment changing name
---------------------------
4. Date of shareholder approval of change, if required
------------------------
Date 09/25/96 /s/ Steve Sierkowski CFO, Secretary
----------------------------- -------------------------------------
(Officer's Signature and Title)
