SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response: 1.0
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
  
Form 3 Holdings Reported.
  
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
MEYERS GEOFFREY G

(Last) (First) (Middle)
333 NORTH SUMMIT STREET

(Street)
TOLEDO OH 43604

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MANOR CARE INC [ HCR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Executive Vice President & CFO
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 12/31/2004 J 12 A (1) 720 I 401(K) Plan
Common Stock 439,234 D
Common Stock 110 I by Spouse
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Phantom Stock Units $0 12/31/2004 J 69 (2) (2) Common Stock 69 (2) 69 D
Non-Qualified Stock Option (right to buy) $18.75 02/05/2006 02/06/2013 Common Stock 75,000 75,000 D
Non-Qualified Stock Option (right to buy) $19.22 02/05/2005 02/06/2012 Common Stock 90,000 90,000 D
Non-Qualified Stock Option (right to buy) $19.25 02/01/2004 02/02/2011 Common Stock 150,000 150,000 D
Non-Qualified Stock Option (right to buy) $27.75 09/25/1998 12/04/2006 Common Stock 18,000 18,000 D
Non-Qualified Stock Option (right to buy) $32.4375 09/25/2001 09/26/2008 Common Stock 60,000 60,000 D
Non-Qualified Stock Option (right to buy) $33.28 11/03/2003 06/17/2010 Common Stock 92,483 92,483 D
Non-Qualified Stock Option (right to buy) $34.3 02/04/2007 02/05/2014 Common Stock 45,000 45,000 D
Non-Qualified Stock Option (right to buy) $34.95 12/03/2004 12/03/2007 Common Stock 14,237 14,237 D
Non-Qualified Stock Option (right to buy) $39.4375 09/25/1998 12/03/2007 Common Stock 18,000 18,000 D
Explanation of Responses:
1. Amount represents the number of units credited in 2004 to reporting persons 401K account for quarterly dividends. Shares were credited based upon the following prices: 1st quarter-$35.80; 2nd quarter-$30.49; 3rd quarter-$26.96; 4th quarter-$34.12.
2. Phantom Stock activity represents the number of phantom stock units credited in 2004 to the reporting person's account in Manor Care, Inc.'s Senior Management Savings Plan for Cororate Officers to be paid 100% in cash upon reporting person's retirement or earlier termination of emploiyment with the company. During 2004, the prices at the time the phantom units were credited were as follows: 1st quarter-$35.80; 2nd quarter-$30.49; 3rd quarter-$26.96; 4th quarter-$34.12. Dates of exercisablilty and expiration, and exercise price are not applicable
Meyers, Geoffrey G. 01/25/2005
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** 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 is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.