-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, R5cI6iU9dzXJU1umDd4bDf5MoxkSdFMVZAxy43S2RsUsn9ygOKt+Tm1wA9l6bnKV dmb5NZ45V+fWW7O/7TdfzQ== 0000898430-99-003986.txt : 19991027 0000898430-99-003986.hdr.sgml : 19991027 ACCESSION NUMBER: 0000898430-99-003986 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991018 FILED AS OF DATE: 19991026 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: TOTAL RENAL CARE HOLDINGS INC CENTRAL INDEX KEY: 0000927066 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 510354549 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 001-04034 FILM NUMBER: 99733958 BUSINESS ADDRESS: STREET 1: 21250 HAWTHORNE BLVD STREET 2: SIE 800 CITY: TORRANCE STATE: CA ZIP: 90503-5517 BUSINESS PHONE: 3107922600 MAIL ADDRESS: STREET 1: 21250 HAWTHORNE BLVD SUITE 800 STREET 2: 21250 HAWTHORNE BLVD SUITE 800 CITY: TORRANCE STATE: CA ZIP: 90503-5517 FORMER COMPANY: FORMER CONFORMED NAME: TOTAL RENAL CARE INC DATE OF NAME CHANGE: 19940719 COMPANY DATA: COMPANY CONFORMED NAME: THIRY KENT J CENTRAL INDEX KEY: 0001097391 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: C/O TOTAL RENAL CARE HOLDINGS INC STREET 2: 21250 HAWTHORNE BLVD CITY: TORRANCE STATE: CA ZIP: 90503 MAIL ADDRESS: STREET 1: C/O TOTAL RENAL CARE HOLDINGS INC STREET 2: 21250 HAWTHORNE BLVD CITY: TORRANCE STATE: CA ZIP: 90503 3 1 INITIAL STMT. OF BENEFICIAL OWNERSHIP OF SEC. =============================================================================== /------------------------------/ / OMB APPROVAL / /------------------------------/ / OMB Number: 3235-0104 / / Expires: September 30, 1998 / / Estimated average burden / / hours per response...... 0.5 / /------------------------------/ +--------+ | FORM 3 | U.S. SECURITIES AND EXCHANGE COMMISSION +--------+ WASHINGTON, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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 (Print or Type Responses) - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Thiry Kent J ---------------------------------------------------------------------------- (Last) (First) (Middle) c/o Total Renal Care Holdings, Inc. 21250 Hawthorne Blvd. ---------------------------------------------------------------------------- (Street) Torrance CA 90503 ---------------------------------------------------------------------------- (City) (State) (Zip) 2. Date of Event Requiring Statement (Month/Day/Year) 10/18/99 -------------- 3. IRS Identification Number of Reporting Person if an Entity (Voluntary) -------------- 4. Issuer Name and Ticker or Trading Symbol Total Renal Care Holdings, Inc. ------------------------------- (TRL) ----- 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) [x] Director [x] Officer [ ] 10% Owner [ ] Other (give title below) (specify below) Chairman of the Board and Chief Executive Officer ---------------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) ---------------------------- 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 BENEFICIALLY OWNED
- -------------------------------------------------------------------------------- 1. Title 2. Amount of 3. Ownership Form: 4. Nature of of Securities Bene- Direct (D) or Indirect Bene- Security ficially Owned Indirect (I) ficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5) - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- Common Stock 12,500 I By trust - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - --------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. FORM 3 (continued) TABLE II--DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities)
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Date Exer- 3. Title and Amount of Securities 4. Conversion 5. Ownership 6. Nature of In- Security (Instr. 4) cisable and Underlying Derivative Security or Form of direct Bene- Expiration (Instr. 4) Exercise Derivative ficial Date Price Security: Ownership (Month/Day/ of Direct (D) (Instr. 5) Year) Derivative or In- ---------------------------------------------------- Security direct (I) Date Expira- Amount or (Instr. 5) Exer- tion Title Number of cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Options (16b-3 Plan) (1) 10/18/09 Common Stock 500,000 $ 6.00 D - ------------------------------------------------------------------------------------------------------------------------------------ (Right to Buy) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) Twenty-five percent of the options vest each year on the anniversary of the date of the grant.
**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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. /s/ Kent J. Thiry October 25, 1999 ------------------------------- ---------------- **Signature of Reporting Person Date -----END PRIVACY-ENHANCED MESSAGE-----