0000899243-19-005510.txt : 20190301 0000899243-19-005510.hdr.sgml : 20190301 20190301182739 ACCESSION NUMBER: 0000899243-19-005510 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190301 FILED AS OF DATE: 20190301 DATE AS OF CHANGE: 20190301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HENDRICKSON CAREY P CENTRAL INDEX KEY: 0001482760 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13445 FILM NUMBER: 19651147 MAIL ADDRESS: STREET 1: 400 S. RECORD STREET CITY: DALLAS STATE: TX ZIP: 75202 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CAPITAL SENIOR LIVING CORP CENTRAL INDEX KEY: 0001043000 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-NURSING & PERSONAL CARE FACILITIES [8050] IRS NUMBER: 752678809 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 14160 DALLAS PARKWAY STREET 2: SUITE 300 CITY: DALLAS STATE: TX ZIP: 75254 BUSINESS PHONE: 9727705600 MAIL ADDRESS: STREET 1: 14160 DALLAS PARKWAY STREET 2: SUITE 300 CITY: DALLAS STATE: TX ZIP: 75254 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-03-01 0 0001043000 CAPITAL SENIOR LIVING CORP CSU 0001482760 HENDRICKSON CAREY P 14160 DALLAS PARKWAY SUITE 300 DALLAS TX 75254 0 1 0 0 Executive Vice President & CFO Common Stock 2019-03-01 4 D 0 2280 0.00 D 252105 D Represents shares of performance-based restricted stock that were previously reported as beneficially owned by the reporting person as of February 24, 2016, but were subsequently forfeited due to the Company achieving 82.5% (but not 100%) of the performance target with respect to such shares for fiscal 2018. /s/ Carey P. Hendrickson 2019-03-01