5: Annual statement of changes in beneficial ownership of securities
Published on February 14, 2003
- -------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION -----------------------------
FORM 5 WASHINGTON, D.C. 20549 OMB APPROVAL
- -------- -----------------------------
/ / CHECK BOX IF NO LONGER ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0362
SUBJECT TO SECTION 16. EXPIRES: JANUARY 31, 2005
FORM 4 OR FORM 5 OBLI- Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN
GATIONS MAY CONTINUE. Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 1.0
SEE INSTRUCTION 1(b). Section 30(h) of the Investment Company Act of 1940 -----------------------------
/ / FORM 3 HOLDINGS REPORTED
/ / FORM 4 TRANSACTIONS REPORTED
- ------------------------------------------------------------------------------------------------------------------------------------
1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s)
to Issuer (Check all applicable)
McNamara Donald J. Omega Healthcare Investors, Inc. (NYSE:OHI) X Director X 10% Owner
---- ----
- ------------------------------------------------------------------------------------------- Officer (give ** Other
(Last) (First) (Middle) 3. IRS Identification 4. Statement for ---- title below) ---- (specify
Number of Reporting Month/Year below)
4200 Texas Commerce Tower West, Person, if an entity --------------------------
2200 Ross Avenue (voluntary) February 11, 2003
- ------------------------------------------- -------------------------------------------------------------
(Street) 5. If Amendment, 7. Individual or Joint/Group Reporting
Date of Original (check applicable line)
(Month/Year)
_X_Form Filed by One
Dallas Texas 75201 Reporting Person
- -------------------------------------------
(City) (State) (Zip) ___Form Filed by More than One
Reporting Person
- ------------------------------------------------------------------------------------------------------------------------------------
TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
- ------------------------------------------------------------------------------------------------------------------------------------
1. Title of 2. Trans- 2A. Deemed 3. Trans- 4. Securities Acquired (A) or 5. Amount of 6. Owner- 7. Nature of
Security action Execution action Disposed of (D) Securities ship Indirect
(Instr. 3) Date Date, if Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial
any (Instr. 8) Owned at Direct Ownership
(Month/ (Month/ end of (D) or (Instr. 4)
Day/ Day/ ------------------------------ Issuer's Indirect
Year) Year) Amount (A) or Price Fiscal Year (I)
(D) (Instr. 3 (Instr. 4)
and 4)
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock 12/26/02 G 1,368 D N/A 165,333 D
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
*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.
FORM 5 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
- ---------------------------------------------------------------------------------------------------------------------------
1. Title of 2. Conver- 3. Trans- 3A. Deemed 4. Trans- 5. Number of 6. Date Exer-
Derivative Security sion of action Execution action Derivative cisable and
(Instr. 3) Exercise Date Date, if Code Securities Ac- Expiration
Price of (Month/ any (Instr. 8) quired (A) or Date
Deriv- Day/ (Month/ Disposed of (Month/Day/
ative Year) Day/Year) (D) Year)
Security (Instr. 3, 4, and 5)
-------------------- -----------------
(A) (D) Date Expir-
Exer- ation
cisable Date
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
7. Title and Amount of 8. Price of 9. Number of 10. Ownership 11. Nature of
Underlying Securities Derivative Derivative of Derivative Indirect
(Instr. 3 and 4) Security Securities Security: Beneficial
(Instr. 5) Beneficially Direct (D) Ownership
Owned at End (Instr. 4) (Instr. 4)
of Year
or Indirect
(I) (Instr. 4)
- ------------------------------------
Amount or
Title Number of
Shares
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------
Explanation of Responses:
/s/ DONALD J. McNAMARA 2/11/03
----------------------------------- -----------
**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