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- ------ U.S. SECURITIES AND EXCHANGE COMMISSION ------------------------------
FORM 4 WASHINGTON, DC 20549 OMB APPROVAL
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STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0287
[ ] Check this box if no Expires: December 31, 2001
longer subject to Filed pursuant to Section 16(a) of the Securities Estimated average burden
Section 16. Form 4 Exchange Act of 1934, Section 17(a) of the hours per response.........0.5
or Form 5 obligations Public Utility Holding Company Act of 1935 ------------------------------
may continue. See or Section 30(f) of the Investment Company
Instruction 1(b). Act of 1940
(Print or Type Response)
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s)
PASQUALE DOUGLAS M. ARV ASSISTED LIVING, INC. (SRS) to Issuer (Check all applicable)
- -------------------------------------------- ---------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
245 FISCHER AVENUE, SUITE D-1 Number of Reporting Month/Year Officer Other (specify
- -------------------------------------------- Person (Voluntary) APRIL, 2000 ---- --- below)
(Street) ------------------- (give title below)
COSTA MESA CALIFORNIA 92626 5. If Amendment, PRESIDENT AND CHIEF EXECUTIVE OFFICER
- -------------------------------------------- Date of Original -------------------------------------
(City) (State) (Zip) (Month/Year)
7. Individual or Joint/Group Filing
------------------- (Check Applicable Line)
X Form filed by One
---- Reporting Person
Form filed by More than
---- One Reporting Person
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TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of
(Instr. 3) action action or Disposed of (D) Securities Form: Indirect
Date Code (Instr. 3, 4 and 5) Beneficially Direct Beneficial
(Instr. 8) Owned at (D) or Ownership
(Month/ End of Month Indirect (Instr. 4)
Day/ --------------------------------------- (Instr. 3 and 4) (I)
Year) Code V Amount (A) or Price (Instr. 4)
(D)
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COMMON STOCK 04/25/00 P 7,500 A $1.125 9,800 D
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COMMON STOCK 04/25/00 P 300 A $1.00 9,800 D
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REMINDER: REPORT ON A SEPARATE LINE FOR EACH CLASS OF SECURITIES BENEFICIALLY OWNED DIRECTLY OR INDIRECTLY. (Over)
*IF THE FORM IS FILED BY MORE THAN ONE REPORTING PERSON, SEE INSTRUCTION 4(b)(v). SEC 1474 (3/99)
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FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Code V (A) (D) Date Expira- Title Amount or
Exer- tion Number of
cisable Date Shares
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9. Number of 10. Ownership 11. Nature of
Derivative Form of Indirect
Securities Derivative Beneficial
Beneficially Security: Ownership
Owned at End Direct (D) (Instr. 4)
of Month or Indirect (I)
(Instr. 4) (Instr. 4)
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Explanation of Responses:
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
/s/ DOUGLAS M. PASQUALE May 3, 2000
Note: File three copies of this Form, one of which must be manually signed. ------------------------------- ---------------
If space provided is insufficient, see Instruction 6 for procedure. **Signature of Reporting Person Date
Douglas M. Pasquale
Potential persons who are to respond to the collection of information Page 2 of 2
contained in this form are not required to respond unless the form SEC 1474 (7/96)
displays a currently valid OMB Number.
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