0001104659-19-072191.txt : 20191212 0001104659-19-072191.hdr.sgml : 20191212 20191212160452 ACCESSION NUMBER: 0001104659-19-072191 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191211 FILED AS OF DATE: 20191212 DATE AS OF CHANGE: 20191212 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: POTTER KATHERINE E. CENTRAL INDEX KEY: 0001543460 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-16817 FILM NUMBER: 191281919 MAIL ADDRESS: STREET 1: C/O FIVE STAR QUALITY CARE, INC. STREET 2: 400 CENTRE STREET CITY: NEWTON STATE: MA ZIP: 02458 FORMER NAME: FORMER CONFORMED NAME: Potter Katherine E. DATE OF NAME CHANGE: 20120228 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 2019-12-11 0 0001159281 FIVE STAR SENIOR LIVING INC. NASDAQ:FVE 0001543460 POTTER KATHERINE E. C/O FIVE STAR SENIOR LIVING INC., 400 CENTRE STREET NEWTON MA 02458 0 1 0 0 President and CEO Common Stock 2019-12-11 4 A 0 10000 A 29600 D Transaction reported is grant of shares pursuant to the issuer's equity compensation plan. On September 30, 2019, the issuer effected a reverse stock split (the "Reverse Split") pursuant to which every ten shares of common stock of the issuer were converted and reclassified into one share of common stock, subject to the receipt of cash in lieu of fractional shares. The amount in the table reflects the aggregate shares owned after giving effect to the Reverse Split. /s/ Katherine E. Potter 2019-12-11