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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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(Print or Type Responses)
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1. Name and Address of Reporting Person* 2. Date of Event 4. Issuer Name and Ticker or 6. If Amendment,
Requiring Statement Trading Symbol Date of Original
GIFFORD PATRICIA J. (Month/Day/Year) (Month/Day/Year)
- ---------------------------------------- ARV Assisted Living, Inc. (SRS)
(Last) (First) (Middle) 03/31/99 ---------------------------------- -----------------------
---------------------------- 5. Relationship of Reporting 7. Individual or Joint/
245 Fischer Avenue, Suite D-1 3. IRS or Social Security Person(s) 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
Senior Vice President and
Medical Director
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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 Ownership
(Instr. 4) Indirect (I) (Instr. 4)
(Instr. 5)
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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 Expiration Amount or or Indirect(I)
Exercis- Date Title Number of (Instr. 5)
able Shares
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Employee Stock Option 06/15/00 06/15/08 Common Stock 6,000 $11.75 D
(Right to Buy)
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Employee Stock Option 06/15/01 06/15/08 Common Stock 6,000 $11.75 D
(Right to Buy)
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Employee Stock Option 06/15/02 06/15/08 Common Stock 6,000 $11.75 D
(Right to Buy)
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Employee Stock Option 06/15/03 06/15/08 Common Stock 6,000 $11.75 D
(Right to Buy)
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Employee Stock Option 06/15/04 06/15/08 Common Stock 6,000 $11.75 D
(Right to Buy)
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Explanation of Responses:
/s/ Patricia J. Gifford May 20, 1999
** 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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