UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Christensen Christopher R. C/O THE ENSIGN GROUP, INC. 27101 PUERTA REAL, SUITE 450 MISSION VIEJO, CA 92691 |
 X |  X |  President & CEO |  |
Christensen Family Trust dated 10/24/05 C/O THE ENSIGN GROUP, INC. 27101 PUERTA REAL, SUITE 450 MISSION VIEJO, CA 92691 |
 |  X |  |  |
Christensen Terri M. C/O THE ENSIGN GROUP, INC. 27101 PUERTA REAL, SUITE 450 MISSION VIEJO, CA 92691 |
 |  X |  |  |
/s/ Daniel Walker, as attorney-in-fact for Christopher R. Christensen | 11/08/2007 | |
**Signature of Reporting Person | Date | |
/s/ Daniel Walker, as attorney-in-fact for the Trustee of the Christensen Family Trust dated 10/24/05 | 11/08/2007 | |
**Signature of Reporting Person | Date | |
/s/ Daniel Walker, as attorney-in-fact for Terri M. Christensen | 11/08/2007 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | These shares are directly owned by the Christensen Family Trust dated 10/25/05, a ten percent owner of the issuer, and indirectly by Christopher R. Christensen, a ten percent owner, director and officer of the issuer, and indirectly by Terri M. Christensen, a ten percent owner of the issuer |
(2) | These shares are indirectly owned by Terri M. Christensen as UTMA custodian for and mother of the four minor children, and indirectly owned by Christopher R. Christensen as father of the four minor children |
 Remarks: Exhibit List: Exhibit 24.1 Power of Attorney for Christopher R. Christensen; Exhibit 24.2 Power of Attorney for Christensen Family Trust dated 10/24/05; Exhibit 24.3 Power of Attorney for Terri M. Christensen |