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