<PAGE>
THIS DOCUMENT IS A COPY OF
THE SCHEDULE 13G FILED ON
FEBRUARY 18, 1997 PURSUANT TO
A RULE 201 TEMPORARY HARDSHIP
EXEMPTION.
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G
(AMENDMENT NO. 2)
Under the Securities Exchange Act of 1934
ASSISTED LIVING CONCEPTS, INC.
(Name of issuer)
COMMON STOCK
(Title of class of securities)
04543L 109
(CUSIP number)
Check the following box if a fee is being paid with the statement [_].
(A fee is not required only if the reporting person: (1) has a previous
statement on file reporting beneficial ownership of more than five percent of
the class of securities described in Item 1; and (2) has filed no amendment
subsequent thereto reporting beneficial ownership of five percent or less of
such class.) (See Rule 13d-7.)
* The remainder of this cover page shall be filled out for a reporting
person's initial filing on this form with respect to the subject class of
securities, and for any subsequent amendment containing information which would
alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not
be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange
Act of 1934 ("Act") or otherwise subject to the liabilities of that section of
the Act but shall be subject to all other provisions of the Act (however, see
the Notes).
Page 1 of 6 Pages
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CUSIP NO. 04543l 109 13G PAGE 2 OF 6 PAGES
- ----------------------- ---------------------
- ------------------------------------------------------------------------------
NAME OF REPORTING PERSON
1 Keren B. Wilson
S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
- ------------------------------------------------------------------------------
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
2 (a) [_]
(b) [_]
- ------------------------------------------------------------------------------
SEC USE ONLY
3
- ------------------------------------------------------------------------------
CITIZENSHIP OR PLACE OF ORGANIZATION
4
United States
- ------------------------------------------------------------------------------
SOLE VOTING POWER
5
NUMBER OF 455,000 (excluding 53,333 option shares)
SHARES -----------------------------------------------------------
SHARED VOTING POWER
BENEFICIALLY 6
0
OWNED BY
-----------------------------------------------------------
EACH SOLE DISPOSITIVE POWER
7
REPORTING 455,000 (excluding 53,333 option shares)
PERSON -----------------------------------------------------------
SHARED DISPOSITIVE POWER
WITH 8
0
- ------------------------------------------------------------------------------
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
9
508,333
- ------------------------------------------------------------------------------
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
10
- ------------------------------------------------------------------------------
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
11
9.1%
- ------------------------------------------------------------------------------
TYPE OF REPORTING PERSON*
12
IN
- ------------------------------------------------------------------------------
*SEE INSTRUCTION BEFORE FILLING OUT!
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ITEM 1(A). Name of Issuer:
Assisted Living Concepts, Inc.
ITEM 1(B). Address of Issuer's Principal Executive offices:
9955 S.E. Washington
Suite 201
Portland, Oregon 97216
ITEM 2(A). Name of Person Filing:
Keren B. Wilson
ITEM 2(B). Address of Principal Business Office:
c/o Assisted Living Concepts, Inc.
9955 S.E. Washington
Suite 201
Portland, Oregon 97216
ITEM 2(C). Citizenship:
United States
ITEM 2(D). Title of Class of Securities:
Common Stock
ITEM 2(E). CUSIP Number:
The CUSIP number for the Common Stock is 04543L 109.
ITEM 3. If this statement is filed pursuant to Rules 13d-1(b), or 13d-
2(b), check whether the person filing is a:
Not applicable.
Page 3 of 6 Pages
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ITEM 4. Ownership
The following information is as of December 31, 1996:
(a) Amount Beneficially Owned: 508,333
Includes 53,333 shares of Common Stock that are subject to
options that are immediately exercisable.
(b) Percent of Class: 9.1%
(Based on the number of shares outstanding as reported in
the Issuer's Form 10-Q for the fiscal quarter ended
September 30, 1996.)
(c) Number of Shares as to which such person has:
(i) sole power to vote or to direct the vote: 455,000
(excludes 53,333 shares subject to call options).
(ii) shared power to vote or to direct the vote: None.
(iii) sole power to dispose or to direct the disposition
of: 455,000 (excludes 53,333 shares subject to call
options).
(iv) shared power to dispose or to direct the disposition
of: None.
ITEM 5. Ownership of Five Percent or less of a Class:
Not applicable.
ITEM 6. Ownership of More than Five Percent on Behalf of Another Person:
Not Applicable.
ITEM 7. Identification and Classification of the Subsidiary which
Acquired the Security Being Reported on By the Parent Holding
Company:
Not Applicable.
Page 4 of 6 Pages
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ITEM 8. Identification and Classification of Members of the Group:
Not Applicable.
ITEM 9. Notice of Dissolution of Group:
Not Applicable.
ITEM 10. Certification:
Not Applicable.
Page 5 of 6 Pages
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SIGNATURE
---------
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
Date: February 14, 1997
/s/ KEREN B. WILSON
-------------------
Keren B. Wilson
Page 6 of 6 Pages
