0001633878-19-000001.txt : 20190605 0001633878-19-000001.hdr.sgml : 20190605 20190605161631 ACCESSION NUMBER: 0001633878-19-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190605 FILED AS OF DATE: 20190605 DATE AS OF CHANGE: 20190605 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hartman Robert CENTRAL INDEX KEY: 0001633878 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33459 FILM NUMBER: 19879900 MAIL ADDRESS: STREET 1: 6633 N. LINCOLN AVENUE CITY: LINCOLNWOOD STATE: IL ZIP: 60712 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2019-06-05 0 0001351051 Genesis Healthcare, Inc. GEN 0001633878 Hartman Robert C/O GENESIS HEALTHCARE, INC. 101 EAST STATE STREET KENNETT SQUARE PA 19348 1 0 0 0 Class A Common Stock 2019-06-05 4 A 0 124079 0 A 304531 D Class A Common Stock 1190955 I See footnote Class A Common Stock 779766 I See footnote Grant of restricted stock units under the Issuer's 2015 Omnibus Equity Incentive Plan. Includes 124,079 unvested restricted stock units and 52,000 vested 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 Midway Gen Capital, LLC, of which Mr. Hartman may be deemed to be the beneficial owner. Mr. Hartman disclaims beneficial ownership of such Class A Shares, except to the extent of Mr. Hartman's pecuniary interest therein. Represents Class A Shares held by GHC Class B LLC, of which Mr. Hartman may be deemed to be the beneficial owner. Mr. Hartman disclaims beneficial ownership of such Class A Shares, except to the extent of Mr. Hartman's pecuniary interest therein. By: Michael Berg, Attorney-in-Fact for: Robert Hartman 2019-06-05