U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 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 to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
--------------------------------------------------------------------------------
1. Name and Address of Reporting Person*
Pickett C. Taylor
--------------------------------------------------------------------------------
(Last) (First) (Middle)
3509 Houcks Mill Road
--------------------------------------------------------------------------------
(Street)
Monkton MD 21111
--------------------------------------------------------------------------------
(City) (State) (Zip)
--------------------------------------------------------------------------------
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
June 2001
--------------------------------------------------------------------------------
5. If Amendment, Date of Original (Month/Year)
--------------------------------------------------------------------------------
6. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[x] Officer (give title below) [_] Other (specify below)
Chief Executive Officer
--------------------------------------------------------------------------------
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
================================================================================
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
------------------------------------------------------------------------------------------------------------------------------------
Common Stock 6/12/01 A V 50,000* A $2.32 50,000 D
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
*Common Stock acquired represents 50,000 shares of restricted stock granted
------------------------------------------------------------------------------------------------------------------------------------
under the Company's Stock Option and Restricted Stock Plan which shares vest
------------------------------------------------------------------------------------------------------------------------------------
on June 12, 2003.
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
* 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 Response) (Over)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
================================================================================
10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
------------------------------------------------------------------------------------------------------------------------------------
Options
(right to buy) $2.32 6/12/01 A V A * * common stock 172,413 $2.32 D
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
Options
(right to buy) $2.32 6/12/01 A V A ** ** common stock 627,587 $2.32 800,000 D
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
Explanation of Responses:
*Options are exercisable as to 43,103 shares on December 31, 2002, as to 43,103
shares on June 12, 2003, as to 43,103 shares ratably month by month over the
twelve months of service in 2004 and as to the remaining 43,104 shares ratably
(month by month) over the first six months of service in 2005. Options expire 10
years from date of grant.
**Options are exercisable as to 50% of the award after optionee has performed
two years of service (June 12, 2003) and the remaining 50% will become
exercisable ratably (month by month) over the 24 months of optionee's service
following the second anniversary of the grant date. Options expire 10 years from
date of grant.
/s/ C. TAYLOR PICKETT July 10, 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