0001633878-20-000002.txt : 20201203 0001633878-20-000002.hdr.sgml : 20201203 20201203180348 ACCESSION NUMBER: 0001633878-20-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201201 FILED AS OF DATE: 20201203 DATE AS OF CHANGE: 20201203 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: 201367965 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 2020-12-01 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 2020-12-01 4 J 0 1335565.5 0.4789 D 0 I By HKT1 LLC Class A Common Stock 2020-12-01 4 J 0 1335565.5 0.4789 A 1335565.5 I By HKT1 LLC Class A Common Stock 284729 D Class A Common Stock 779766 I By GHC Class B LLC On December 1, 2020, for estate planning purposes, Mr. Hartman and the Robert Hartman Family Trust, which together owned 100% of HKT1 LLC, sold the entirety of their interests in HKT1 LLC to the Kutner Children Trust, a trust for the benefit of members of Mr. Hartman's family and of which Mr. Hartman serves as the investment manager. The consideration for the transaction described in footnote 1 consisted of promissory notes for $639,602.32, or $0.4789 per share of Class A Common Stock (the "Shares") held by HKT1 LLC. Prior to the transaction described in footnote 1, HKT1 LLC was owned by Mr. Hartman and the Robert Hartman Family Trust. Mr. Hartman disclaims beneficial ownership of the Shares, except to the extent of his pecuniary interest therein. Following the transaction described in footnote 1, HKT1 LLC is now owned 100% by the Kutner Children Trust. Mr. Hartman disclaims beneficial ownership of the Shares, except to the extent of his pecuniary interest therein. Includes 176,079 vested restricted stock units that have not yet been paid in the Shares. Mr. Hartman disclaims beneficial ownership of the Shares, except to the extent of his pecuniary interest therein. By: Michael Berg, Attorney-in-Fact for: Robert Hartman 2020-12-03