| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
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Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10. | ||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
HEALTHCARE SERVICES GROUP INC [ HCSG ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 12/31/2023 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock | 01/03/2024 | M | 2,816 | A | $0 | 28,572 | D | |||
| Common Stock | 01/04/2024 | M | 1,700 | A | $0 | 30,272 | D | |||
| Common Stock | 01/04/2024 | M | 2,003 | A | $0 | 32,275 | D | |||
| Common Stock | 01/04/2024 | M | 3,318 | A | $0 | 35,593 | D | |||
| Common Stock | 01/04/2024 | F | 3,742 | D | $0 | 31,851 | D | |||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Phantom Stock | (1) | 12/31/2023 | A | 2,857 | (2) | (2) | Common Stock | 2,857 | $10.37 | 12,237(3) | D | ||||
| Restricted Stock Units | (1) | 01/03/2024 | A | 31,226 | (4) | (4) | Common Stock | 31,226 | $0 | 31,226 | D | ||||
| Stock Option (right to buy) | $10.36 | 01/03/2024 | A | 31,944 | (5) | 01/03/2034 | Common Stock | 31,944 | $10.36 | 31,944 | D | ||||
| Restricted Stock Units | (1) | 01/03/2024 | M | 2,816 | (6) | (6) | Common Stock | 2,816 | $0 | 2,816 | D | ||||
| Restricted Stock Units | (1) | 01/04/2024 | M | 1,700 | (7) | (7) | Common Stock | 1,700 | $0 | 0 | D | ||||
| Restricted Stock Units | (1) | 01/04/2024 | M | 2,003 | (8) | (8) | Common Stock | 2,003 | $0 | 4,004 | D | ||||
| Restricted Stock Units | (1) | 01/04/2024 | M | 3,318 | (9) | (9) | Common Stock | 3,318 | $0 | 9,953 | D | ||||
| Explanation of Responses: |
| 1. Shares issued at the conversion rate of 1-for-1. |
| 2. Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer. |
| 3. Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan. |
| 4. These Restricted Stock Units vest at the rate of 20% annually, commencing on the first anniversary of the January 3, 2024 grant date. |
| 5. These Options shall become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 3, 2024 grant date. |
| 6. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 3, 2020 grant date. |
| 7. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2019 grant date. |
| 8. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2021 grant date. |
| 9. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2022 grant date. |
| Remarks: |
| /s/ Michael Harrity, by Power of Attorney | 01/08/2024 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. | ||