SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

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
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Check this 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*
TRICHE TIMOTHY

(Last) (First) (Middle)
22917 PACIFIC COAST HWY
SUITE 350

(Street)
MALIBU CA 90265

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
LTC PROPERTIES INC [ LTC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
09/14/2004
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 Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 4,559 I See footnote(1)
Common Stock 09/14/2004 09/14/2004 F 6,000 A $5.688 25,000 D
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options $5.688 09/14/2004 09/14/2004 F 3,000 05/02/2003(2) 05/02/2010 Common Stock 3,000 $5.688 0 D
Stock Options $5.688 09/14/2004 09/14/2004 F 3,000 05/02/2003(2) 05/02/2010 Common Stock 3,000 $5.688 0 D
Stock Options $4.06 04/23/2004 04/23/2011 Common Stock 2,000 2,000 D
Stock Options $4.06 04/23/2005 04/23/2012 Common Stock 2,000 4,000 D
Stock Options $4.06 04/23/2006 04/23/2013 Common Stock 2,000 6,000 D
Stock Options $5.17 10/03/2004 10/03/2011 Common Stock 3,000 9,000 D
Stock Options $5.17 10/03/2005 10/03/2012 Common Stock 3,000 12,000 D
Stock Options $5.17 10/03/2006 10/03/2013 Common Stock 3,000 15,000 D
Explanation of Responses:
1. Company contribution/reinvestment of dividend held on shares held in deferred compensation trust. Individuals have no voting rights over such shares.
2. Date exercisable corrected from previous filings in accordance with specific provision of The 1998 Equity Participation Plan.
/s/ Timothy J Triche 09/16/2004
** 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.