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- -------- U.S. SECURITIES AND EXCHANGE COMMISSION ---------------------------
FORM 3 WASHINGTON, DC 20549 OMB APPROVAL
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OMB Number: 3235-0104
Expires: September 30, 1998
Estimated average burden
hours per response......0.5
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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1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date
Statement Trading Symbol of Original
LODA LAURA J. (Month/Day/Year) (Month/Day/Year)
- ---------------------------------------- ARV Assisted Living, Inc. (SRS)
(Last) (First) (Middle) 09/02/98 ---------------------------------- -----------------------
---------------------------- 5. Relationship of Reporting 7. Individual or Joint/
245 Fischer Avenue, Suite D-1 3. IRS or Social Security Person to Issuer Group Filing (Check
- ---------------------------------------- Number of Reporting (Check all applicable) applicable line)
(Street) Person (Voluntary)
Director 10% Owner X Form filed by
Costa Mesa CA 92626 ---------------------------- ----- ----- ----- One Reporting
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(City) (State) (Zip) X Officer Other
----- (give title ----- (specify Form filed by
below) below) ----- More than One
Reporting Person
Vice President of Human Resources
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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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Common Stock 1,000 shares D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 1
*If the form is filed by more than one Reporting Person, see Instruction 5(b)(v). SEC 1473 (7-96)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative Security 2. Date Exercisable 3. Title and Amount of 4. Conversion 5. Ownership 6. Nature of
(Instr. 4) and Expiration Securities Underlying or Exercise Form of Indirect
Date (Month/ Derivative Security Price of Derivative Beneficial
Day/Year) (Instr. 4) Derivative Security: Ownership
------------------------------------------------- Security Direct (D) (Instr. 5)
Date Expira- Title Amount or or Indirect
Exercis- tion Date Number of (I)
able Shares (Instr. 5)
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Stock Option 07/01/00 07/01/08 Common Stock 5,000 $12.50 D
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Stock Option 07/01/01 07/01/08 Common Stock 5,000 $12.50 D
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Stock Option 07/01/02 07/01/08 Common Stock 5,000 $12.50 D
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Stock Option 07/01/03 07/01/08 Common Stock 5,000 $12.50 D
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Explanation of Responses:
/s/ LAURA J. LODA September 2, 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.
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 Page 2
SEC 1473 (7-96)
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