SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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FORM 8-A
FOR REGISTRATION OF CERTAIN CLASSES OF SECURITIES
PURSUANT TO SECTION 12(b) OR 12(g) OF THE
SECURITIES EXCHANGE ACT OF 1934
Diversified Senior Services, Inc.
(Exact name of the Registrant as specified in its charter)
North Carolina 56-1973923
(State or other jurisdiction of (I.R.S. Employer
incorporation or organization) Identification No.)
915 West Fourth Street
Winston-Salem, North Carolina 27101
(Address of principal executive offices) (Zip Code)
If this form relates to the registration of a class of securities pursuant
to Section 12(b) of the Exchange Act and is effective upon filing pursuant to
General Instruction A.(c), please check the following box. [ ]
If this form relates to the registration of a class of securities pursuant to
Section 12(g) of the Exchange Act and is to become effective simultaneously with
the effectiveness of a concurrent registration statement under the Securities
Act of 1933 pursuant to General Instruction A.(d) please check the following
box. [X]
Securities to be registered pursuant to Section 12(b) of the Act: None
Securities to be registered pursuant to Section 12(g) of the Act:
Common Stock, no par value
(Title of class)
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INFORMATION REQUIRED IN REGISTRATION STATEMENT
ITEM 1. DESCRIPTION OF REGISTRANT'S SECURITIES TO BE REGISTERED
The description of the Common Stock of Diversified Senior Services, Inc.
(the "Company") to be registered hereunder is set forth under the caption
"Description of Securities" in the Prospectus included within the Registration
Statement of the Company on Amendment No. 1 to Form SB-2 filed on August 26,
1997 with the Securities and Exchange Commission (Registration No. 333-34367),
which description is incorporated herein by reference.
ITEM 2. EXHIBITS
All of the following Exhibits are incorporated by reference to the
Company's Registration Statement on Form SB-2 and Exhibits thereto (Registration
No. 333-34367):
1. The Company's Registration Statement on Form
SB-2 and the Exhibits thereto.
2. The Articles of Incorporation of the
Company.
3. The Bylaws of the Company.
4. Specimen of the Common Stock certificate.
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SIGNATURE
Pursuant to the requirements of Section 12 of the Securities Exchange Act
of 1934, the Registrant has duly caused this Registration Statement to be signed
on its behalf by the undersigned, thereto duly authorized.
DIVERSIFIED SENIOR SERVICES, INC.
(Registrant)
By: /S/ SUSAN L. CHRISTIANSEN
Susan L. Christiansen
Chief Operating Officer
Date: November 5, 1997
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