0001104659-20-136299.txt : 20201216 0001104659-20-136299.hdr.sgml : 20201216 20201216161822 ACCESSION NUMBER: 0001104659-20-136299 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201214 FILED AS OF DATE: 20201216 DATE AS OF CHANGE: 20201216 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: 201392627 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 tm2038461-1_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2020-12-14 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 2020-12-14 4 A 0 25000 0 A 55223 D Transaction reported is grant of shares pursuant to issuer's equity compensation plan. /s/ Katherine E. Potter 2020-12-15