Form 3 Hicks George T

3 - Initial statement of beneficial ownership of securities

Published: 2006-07-27 16:56:28
Submitted: 2006-07-27
Period Ending In: 2006-07-25
edgar123.html FORM 3


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SEC FORM 3

SEC Form 3
FORM 3 UNITED STATES 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
or Section 30(h) of the Investment Company Act of 1940
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OMB Number: 3235-0104
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1. Name and Address of Reporting Person*
HICKS GEORGE T

(Last) (First) (Middle)
111 WESTWOOD PLACE
SUITE 200

(Street)
BRENTWOOD TN 37027

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/25/2006
3. Issuer Name and Ticker or Trading Symbol
Brookdale Senior Living Inc. [ BKD ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Executive Vice President
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
No securities are beneficially owned 0 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
/s/ George T. Hicks 07/25/2006
** 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 5 (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.
1
edgar123.xml FORM 3
Schema Version:
X0202
Document Type:
3
Period Of Report:
2006-07-25
No Securities Owned:
0

Issuer

Issuer Cik
0001332349
Issuer Name
Brookdale Senior Living Inc.
Issuer Trading Symbol
BKD

Reporting Owner

Reporting Owner Id

Rpt Owner Cik
0001251139
Rpt Owner Name
HICKS GEORGE T

Reporting Owner Address

Rpt Owner Street1
111 WESTWOOD PLACE
Rpt Owner Street2
SUITE 200
Rpt Owner City
BRENTWOOD
Rpt Owner State
TN
Rpt Owner Zip Code
37027

Reporting Owner Relationship

Is Director
0
Is Officer
1
Is Ten Percent Owner
0
Is Other
0
Officer Title
Executive Vice President

Non Derivative Holding

Security Title
No securities are beneficially owned
Shares Owned Following Transaction
0
Direct Or Indirect Ownership
D

Owner Signature

Signature Name
/s/ George T. Hicks
Signature Date
2006-07-25
Additional Files
FileSequenceDescriptionTypeSize
0001005477-06-003714.txt   Complete submission text file   3938
$BKD

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