5: Annual statement of changes in beneficial ownership of securities
Published on February 14, 2002
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 5
ANNUAL 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 to
[_] Section 16. Form 4 or Form 5 obligations may continue.See Instruction 1(b).
[_] Form 3 Holdings Reported
[X] Form 4 Transactions Reported
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1. Name and Address of Reporting Person*
Pickett C. Taylor
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(Last) (First) (Middle)
9690 Deereco Road, Suite 100
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(Street)
Timonium MD 21093
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Omega Healthcare Investors, Inc. (NYSE: OHI)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
12/01
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
Chief Executive Officer
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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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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 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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Explanation of Responses:
* Options vest as to 50% after optionee has performed two years of service, and
the remaining 50% vests ratably over the twenty-four (24) months of optionee's
service following the second anniversary of the grant date.
/s/ C. TAYLOR PICKETT February 6, 2002
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**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.
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