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