10-Q: Quarterly report pursuant to Section 13 or 15(d)
Published on August 14, 2000
------------------------------
OMB APPROVAL
------------------------------
OMB Number
Expires:
Estimated average burden
hours per response ....... 0.5
------------------------------
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
[_] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
- --------------------------------------------------------------------------------
1. Name and Address of Reporting Person*
Erickson Thomas W.
- --------------------------------------------------------------------------------
(Last) (First) (Middle)
- --------------------------------------------------------------------------------
(Street)
3106 Greenbrier Drive
- --------------------------------------------------------------------------------
(City) (State) (Zip)
Dallas Texas 75225
- --------------------------------------------------------------------------------
2. Issuer Name and Ticker or Trading Symbol
Omega Healthcare Investors, Inc. (OHI)
- --------------------------------------------------------------------------------
3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
- --------------------------------------------------------------------------------
4. Statement for Month/Year
January, 2001
- --------------------------------------------------------------------------------
5. If Amendment, Date of Original (Month/Year)
================================================================================
6. Relationship of Reporting Person to Issuer
(Check all applicable)
[x] Director [_] 10% Owner
[ ] Officer (give title below) [_] Other (specify below)
- --------------------------------------------------------------------------------
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
================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
(Over)
(Form 4-07/98)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities)
================================================================================
Explanation of Responses:
* Options to acquire 1,000 shares of common stock at an exercise price of
$3.8125 per share were granted to the undersigned on January 1, 2001.
Options are exercisable as to one-third of the shares after January 1, 2002
as to an additional one-third of the shares after January 1, 2003 and as to
the remaining balance after January 1, 2004, all at an exercise price of
$3.8125. Options expire 11 years after date of grant.
/s/ Thomas W. Erickson February 9, 2001
- --------------------------------------------- -----------------------
**Signature of Reporting Person Date
** 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.
Page 2