TOTAL RENAL CARE HOLDINGS INC
4, 1999-03-26
MISC HEALTH & ALLIED SERVICES, NEC
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| FORM 4 |                         U.S. SECURITIES AND EXCHANGE COMMISSION
  +--------+                               WASHINGTON, D.C. 20549         
                                                                                
[_] Check this box if                                                           
    no longer subject            STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
    to Section 16.                                                              
    Form 4 or Form 5         Filed pursuant to Section 16(a) of the Securities 
    obligations may             Exchange Act of 1934, Section 17(a) of the
    continue. See              Public Utility Holding Company Act of 1935 or
    Instruction 1(b).        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*

      Cosgrove                    Barry                                   C.
- --------------------------------------------------------------------------------
        (Last)                      (First)                        (Middle)

    c/o Total Renal Care Holdings, Inc.   21250 Hawthorne Blvd.
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                                   (Street)

    Torrance                          CA                            90503
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        (City)                      (State)                           (Zip)

2. Issuer Name and Ticker or Trading Symbol Total Renal Care Holdings, Inc.(TRL)
                                           ------------------------------------

3. IRS or Identification Number of Reporting Person if an entity 
   (Voluntary)   3/99
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4. Statement for Month/Year        
                            ---------------------------------------------------

5. If Amendment, Date of Original (Month/Year)
                                              ---------------------------------

 
6. Relationship of Reporting Person(s) to Issuer (Check all applicable)
                                               

   [ ] Director    [X] Officer             [ ] 10% Owner    [ ] Other
                       (give title below)                       (specify below)

   Senior Vice President, General Counsel and Secretary
   ----------------------------------------------------------------

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 ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED

<TABLE> 
<CAPTION> 
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1. Title              2. Trans-  3. Trans-       4. Securities Acquired (A)        5. Amount of         6. Owner-     7. Nature
   of                    action     action          or Disposed of (D)                Securities           ship          of In-
   Security              Date       Code            (Instr. 3, 4 and 5)               Beneficially         Form:         direct
   (Instr. 3)            (Month/    (Instr. 8)                                        Owned at             Direct        Bene-
                         Day/    -----------------------------------------------      End of               (D) or        ficial
                         Year)                                                        Month                Indirect      Owner-
                                  Code       V   Amount        (A) or    Price        (Instr. 3 and 4)     (I)           ship
                                                               (D)                                         (Instr. 4)    (Instr. 4)
- ------------------------------------------------------------------------------------------------------------------------------------
<S>                   <C>        <C>         <C> <C>           <C>       <C>       <C>                  <C>           <C>

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</TABLE> 
Reminder: Report on a separate line for each class of securities beneficially 
owned directly or indirectly. 
* If this form is filed by more than one reporting person, see Instruction 
  4(b)(v).


<PAGE>
 
FORM 4 (continued)

  TABLE II--DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
        (e.g., puts, calls, warrants, options, convertible securities)

<TABLE> 
<CAPTION> 
- -----------------------------------------------------------------------------------------------------------------------------
 1. Title of Derivative            2. Conver-          3. Trans-           4. Transac-            5. Number of Deriv-        
    Security (Instr. 3)               sion or             action              tion Code              ative Securities        
                                      Exercise            Date                (Instr. 8)             Acquired (A) or         
                                      Price of            (Month/                                    Disposed of (D)         
                                      Deriv-              Day/                                       (Instr. 3, 4, and 5)    
                                      ative               Year)                                                              
                                      Security                                                                               

                                                                           ---------------------------------------------------
                                                                           Code      V                 (A)         (D)        

- -----------------------------------------------------------------------------------------------------------------------------
<S>                                <C>                 <C>                 <C>       <C>          <C>              <C> 
                             
- -----------------------------------------------------------------------------------------------------------------------------
Options (16b-3 Plan)               $9 1/16             3/11/99              A          V           200,000                         
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</TABLE> 

 TABLE II--DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
   (e.g., puts, calls, warrants, options, convertible securities)--CONTINUED
<TABLE> 
<CAPTION> 
- ------------------------------------------------------------------------------------------------------------------------------------
                              6. Date Exer-     7. Title and Amount of       8. Price    9. Number       10. Owner-    11. Na-
                                 cisable and       Underlying Securities        of          of Deriv-        ship          ture
                                 Expiration        (Instr. 3 and 4)             Deriv-      ative            Form          of In-
                                 Date                                           ative       Secur-           of De-        direct
                                 (Month/Day/                                    Secur-      ities            rivative      Bene-
                                 Year)                                          ity         Bene-            Secu-         ficial
                                                                                (Instr.     ficially         rity:         Owner-
                               --------------------------------------------     5)          Owned            Direct        ship
                               Date     Expira-              Amount or                      at End           (D) or        (Instr. 
                               Exer-    tion         Title   Number of                      of               Indi-         4)
                               cisable  Date                 Shares                         Month            rect (1)
                                                                                            (Instr. 4)       (Instr. 4)
- ------------------------------------------------------------------------------------------------------------------------------------
<S>                           <C>       <C>     <C>          <C>             <C>         <C>             <C>           <C> 

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                              (1)     3/11/09    Common Stock  200,000                    200,000         D
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</TABLE>           

Explanation of Responses:

(1) Twenty-five percent of the options vest each year on the anniversary of the
    date of grant.

**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.

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.

                              /s/ Barry C. Cosgrove             March 17, 1999
                              -------------------------------  -----------------
                              **Signature of Reporting Person        Date






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