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).
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1. Name and Address of Reporting Person*
Erickson Thomas W.
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(Last) (First) (Middle)
4200 Texas Commerce Tower West, 2200 Ross Avenue
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(Street)
Dallas TX 75201
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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/Day/Year
October 15, 2002
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5. If Amendment, Date of Original (Month/Day/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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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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6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
2A. 3. Disposed of (D) Securities Form: 7.
Deemed Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Execution Code ------------------------------- Owned at End (D) or Indirect
1. Transaction Date, if (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date any ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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Common Stock 10/15/02 A* 581 A $4.30 17,717 D
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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).
(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)
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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 3A. Derivative 6. of Underlying 8. ities Secur- of
Exer- Deem- 4. Securities Date Securities Price Bene- ity: In-
cise 3. ed Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- Execu- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action tion Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date Date,if (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (mm/ any 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- dd/ (mm/dd ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity yy) yy) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Explanation of Responses:
* Grant of stock for payment of Director fees
/S/ THOMAS H. PETERSON October 17, 2002
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**Attorney-In-Fact 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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