SEC Form 4 · accession 0001693042-19-000001
Genesis Healthcare, Inc. · GEN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Paul David Bach
Officer — COO
Period of report
Dec 31, 2018
Accepted (ET)
Jan 3, 2019 · 10:11 am EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001351051
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class A Common Units of FC-GEN Operations Investment, LLCF2 | — | Dec 31, 2018 | J | 186,499 | D | — | — | Class A Common Stock | 186,499 | 186,497 | D |
| Class C Common StockF3 | — | Dec 31, 2018 | J | 32 | D | — | — | Class A Common Stock | 32 | 32 | D |
Explanation of responses
- F1Transfer of shares pursuant to a marital settlement agreement.
- F2Each Class A Common Unit (an "OP Unit") is exchangeable, pursuant to the terms and subject to the limitations of the limited liability company operating agreement of FC-GEN Operations Investment, LLC and subject to certain adjustments, for one share of Class A Common Stock of the Issuer.
- F3Represents shares of Class C Common Stock of the Issuer on an as-converted basis. Concurrently with the exchange of an OP Unit as described in footnote (2), subject to certain adjustments, one share of Class C Common Stock will automatically convert into 0.000174115 shares of Class A Common Stock.