0001104659-21-151667.txt : 20211220
0001104659-21-151667.hdr.sgml : 20211220
20211220160329
ACCESSION NUMBER: 0001104659-21-151667
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211216
FILED AS OF DATE: 20211220
DATE AS OF CHANGE: 20211220
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: 211505242
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
tm2135795-3_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2021-12-16
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
2021-12-16
4
F
0
17780
3.01
D
287443
D
Represents payment of tax liability by withholding securities incident to the vesting of securities issued in accordance with Rule 16b-3.
/s/ Katherine E. Potter
2021-12-20