0001632417-16-000012.txt : 20160609 0001632417-16-000012.hdr.sgml : 20160609 20160609184356 ACCESSION NUMBER: 0001632417-16-000012 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160608 FILED AS OF DATE: 20160609 DATE AS OF CHANGE: 20160609 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Genesis Healthcare, Inc. CENTRAL INDEX KEY: 0001351051 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 101 EAST STATE STREET CITY: KENNETT SQUARE STATE: PA ZIP: 19348 BUSINESS PHONE: 610-444-6350 MAIL ADDRESS: STREET 1: 101 EAST STATE STREET CITY: KENNETT SQUARE STATE: PA ZIP: 19348 FORMER COMPANY: FORMER CONFORMED NAME: Skilled Healthcare Group, Inc. DATE OF NAME CHANGE: 20070209 FORMER COMPANY: FORMER CONFORMED NAME: SHG Holding Solutions Inc DATE OF NAME CHANGE: 20060126 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Whitman Arnold M CENTRAL INDEX KEY: 0001316576 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33459 FILM NUMBER: 161707059 MAIL ADDRESS: STREET 1: 3280 MANSELL ROAD STREET 2: SUITE 280 CITY: ALPHARETTA STATE: GA ZIP: 30022 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2016-06-08 0 0001351051 Genesis Healthcare, Inc. GEN 0001316576 Whitman Arnold M C/O GENESIS HEALTHCARE, INC. 101 EAST STATE STREET KENNETT SQUARE PA 19348 1 0 1 0 Class A Common Stock 2016-06-08 4 A 0 40000 0 A 71302 D Class A Common Stock 6937750 I (3) Class A Common Stock 1003512 I (4) Class A Common Stock 501815 I (5) Grant of restricted stock units under the Issuer's 2015 Omnibus Equity Incentive Plan. Includes 40,000 unvested restricted stock units that have not yet been paid in shares of the Issuer's Class A Common Stock. Represents shares of Class A Common Stock of the Issuer ("Class A Shares") held by HCCF Management Group XI, LLC, of which Mr. Whitman may be deemed to be the beneficial owner. Represents Class A Shares held by HCCF Management Group, Inc., of which Mr. Whitman may be deemed to be the beneficial owner. Represents Class A Shares held by FC Profit Sharing, LLC, of which Mr. Whitman may be deemed to be the beneficial owner as a principal of Formation Capital, LLC, the sole member of FC Profit Sharing, LLC. Mr. Whitman disclaims beneficial ownership of such Class A Shares, except to the extent of Mr. Whitman's pecuniary interest therein. By: Michael Berg, Attorney-in-fact For: Arnold M. Whitman 2016-06-09