0001104659-20-000450.txt : 20200102 0001104659-20-000450.hdr.sgml : 20200102 20200102173404 ACCESSION NUMBER: 0001104659-20-000450 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200101 FILED AS OF DATE: 20200102 DATE AS OF CHANGE: 20200102 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: 20502504 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 2020-01-01 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 2020-01-01 4 J 0 623 0 A 30223 D In connection with a Transaction Agreement, dated as of April 1, 2019, between Diversified Healthcare Trust (formerly known as Senior Housing Properties Trust) ("DHC") and Five Star Senior Living Inc. (the "Issuer"), effective January 1, 2020, DHC completed a pro rata distribution to holders of record of DHC's common shares of beneficial interest as of December 13, 2019 of the right to receive an aggregate of approximately 16,119,563 shares of common stock of the Issuer ("Common Shares"), with cash being paid in lieu of fractional shares. The reporting person received the Common Shares reported in her capacity as a shareholder of DHC. /s/ Katherine E. Potter 2020-01-02