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FORM 3
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 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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<S> <C> <C> <C>
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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
MAY, JACOB Statement Trading Symbol of Original
- ---------------------------------------- (Month/Day/Year) YOUTH SERVICES INTERNATIONAL, INC. (Month/Day/Year)
(Nasdaq: YSII)
(Last) (First) (Middle) 08/31/98 ----------------------------------
1900 CHURCH STREET, SUITE 400 ---------------------------- 5. Relationship of Reporting -----------------------
- ---------------------------------------- 3. IRS or Social Security Person to Issuer 7. Individual or Joint/
(Street) Number of Reporting (Check all applicable) Group Filing (Check
NASHVILLE, TENNESSEE 37203 Person (Voluntary) Director X 10% Owner applicable line)
- -------------------------------------- ----- ----- X Form filed by
(City) (State) (Zip) ---------------------------- Officer Other ----- One Reporting
----- (give ----- (specify Person
title below) below) Form filed by
----- More than One
---------------------------------- Reporting Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect
(Instr. 4) Beneficially Owned Direct (D) or Beneficial
(Instr. 4) Indirect (I) Ownership (Instr. 4)
(Instr. 5)
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Youth Services International, Inc. Common Stock 1,796,300 D
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See Explanation of Responses.
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*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) (8/96)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C>
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1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership
Expiration Date Derivative Security Exercise Form of (Instr. 5)
(Month/Day/ (Instr. 4) Price of Deriv-
Year) Deri- ative
vative Security:
Security Direct
------------------------------------------------- (D) or
Date Expira- Amount or Indirect
Exercis- tion Title Number (I)
able Date of Shares (Instr.
5)
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N/A
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Explanation of Responses:
In the reporting person's original Schedule 13D, filed with the U.S. Securities and Exchange Commission on June 17, 1998, the
reporting person reported the purchase, in the aggregate, of 107,500 shares of the issuer's Common Stock by certain members of his
extended family. The reporting person disclaims any direct or indirect beneficial interest in these shares.
/s/ Jacob May November 16, 1998
**Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- ------------------
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date
Note. File three copies of this form, one of which must be manually signed. Page 2
If space provided is insufficient, See Instruction 6 for procedure.
(Print or Type Responses)
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