0001104659-18-048422.txt : 20180731 0001104659-18-048422.hdr.sgml : 20180731 20180731164107 ACCESSION NUMBER: 0001104659-18-048422 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180730 FILED AS OF DATE: 20180731 DATE AS OF CHANGE: 20180731 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MARTIN GERARD M. CENTRAL INDEX KEY: 0001241557 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-16817 FILM NUMBER: 18981644 MAIL ADDRESS: STREET 1: C/O THE RMR GROUP LLC STREET 2: TWO NEWTON PL., 255 WASH. ST., STE. 300 CITY: NEWTON STATE: MA ZIP: 02458 FORMER NAME: FORMER CONFORMED NAME: MARTIN GERARD M DATE OF NAME CHANGE: 20030613 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FIVE STAR SENIOR LIVING INC. CENTRAL INDEX KEY: 0001159281 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 043516029 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 400 CENTRE STREET CITY: NEWTON STATE: MA ZIP: 02458 BUSINESS PHONE: (617) 796 8387 MAIL ADDRESS: STREET 1: 400 CENTRE STREET CITY: NEWTON STATE: MA ZIP: 02458 FORMER COMPANY: FORMER CONFORMED NAME: FIVE STAR QUALITY CARE, INC. DATE OF NAME CHANGE: 20161006 FORMER COMPANY: FORMER CONFORMED NAME: FIVE STAR QUALITY CARE INC DATE OF NAME CHANGE: 20010918 4 1 a4.xml 4 X0306 4 2018-07-30 0 0001159281 FIVE STAR SENIOR LIVING INC. NASDAQ:FVE 0001241557 MARTIN GERARD M. C/O THE RMR GROUP LLC TWO NEWTON PL., 255 WASH. ST., STE. 300 NEWTON MA 02458 1 0 0 0 Common Stock 2018-07-30 5 G 0 E 12371.9 0 D 0 I See footnote Common Stock 2018-07-30 5 G 0 E 123.719 0 A 123.719 I See footnote Common Stock 244250 D The reported securities were formerly held by The Rye, Inc. On July 30, 2018, The Rye, Inc. distributed the shares of common stock of the Issuer it held to its shareholders, including 123.719 shares of common stock to The Kathleen R. Martin Non-Exempt QTIP Trust-2007, of which Mr. Martin is a trustee and beneficiary. Following these distributions, Mr. Martin may be deemed to continue to indirectly beneficially own the shares of common stock of the Issuer distributed to The Kathleen R. Martin Non-Exempt QTIP Trust-2007, but Mr. Martin disclaims such beneficial ownership except to the extent of his pecuniary interest therein. /s/ Gerard M. Martin 2018-07-30