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FORM 3 OMB APPROVAL
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OMB Number: 3235-0104
Expires: December 31, 2001
Estimated average burden
hours per response .............0.5
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UNITED STATES 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*
TPG Advisors II, Inc.
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(Last) (First) (MI)
201 Main Street, Suite 2420
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(Street)
Fort Worth, TX 76102
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(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/15/99
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3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Genesis Health Ventures, Inc. (GHV)
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5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
[ ] Director [ X ] 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
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Form filed by More than One Reporting Person
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TABLE I - Non-Derivative Securities Beneficially Owned
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<TABLE>
<CAPTION>
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1. Title of Security | 2. Amount of Securities | 3. Ownership Form: | 4. Nature of Indirect Beneficial
(Instr. 4) | Beneficially Owned | Direct (D) or Indirect | Ownership (Instr. 5)
| (Instr. 4) | (I) (Instr. 5) |
<S> <C> <C> <C>
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Common Stock, par value $0.02 | 6,250,000 shares | I | Through investment funds managed by
per share ("Common Stock") | | | Reporting Person
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</TABLE>
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).
Potential persons who are to respond to the collection of Information contained
in this form are not required to respond unless the form displays a currently
valid OMB control number.
(Over)
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<TABLE>
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FORM 3 (continued) Table II -- Derivative Securities Benefically Owned
(e.g., puts, calls, warrants, options, convertible securities)
<S> <C>
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date
| (Month/Day/Year)
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| Date Exercisable | Expiration Date
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Warrants | Issue Date | 11/14/2009
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Series H Senior Convertible Participating | Issue Date | None
Cumulative Preferred Stock | |
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Series 1 Senior Convertible Participating | Issue Date | None
Cumulative Preferred Stock | |
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| |
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3. Title and Amount of Securities | 4. Conversion or Exercise | 5. Ownership Form of Derivative | 6. Nature of Indirect
Underlying Derivative Security | Price of Derivative | Security: Direct (D) or | Beneficial Ownership
(Instr. 4) | Security | Indirect (I) (Instr. 5) | (Instr. 5)
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| Amount or | | |
| Number of | | |
Title | Shares | | |
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| | | | Through investment
Common Stock | 1,000,000 | $5.00 | I | funds managed by
| | | | Reporting Person
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| | | | Through investment
Common Stock | 13,228,604 | $8.75 | I | funds managed by
| | | | Reporting Person
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Non Voting Common | | | | Through investment
Stock, par value | 9,571,452 | $8.75 | I | funds managed by
$0.02 per share | | | | Reporting Person
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Explanation of Responses:
</TABLE>
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB Number.
TPG ADVISORS II, INC.
/s/ Richard A. Ekleberry November 24, 1999
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**Signature of Reporting Person Date
By: Richard A. Ekleberry
Vice President
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