0000731012-13-000025.txt : 20130108 0000731012-13-000025.hdr.sgml : 20130108 20130108150840 ACCESSION NUMBER: 0000731012-13-000025 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121231 FILED AS OF DATE: 20130108 DATE AS OF CHANGE: 20130108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHEA JOHN CHRISTOPHER CENTRAL INDEX KEY: 0001502211 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 13517959 MAIL ADDRESS: STREET 1: 3220 TILLMAN DRIVE STREET 2: SUITE 300 CITY: BENSALEM STATE: PA ZIP: 19020 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HEALTHCARE SERVICES GROUP INC CENTRAL INDEX KEY: 0000731012 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-TO DWELLINGS & OTHER BUILDINGS [7340] IRS NUMBER: 232018365 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3220 TILLMAN DRIVE STREET 2: SUITE 300 CITY: BENSALEM STATE: PA ZIP: 19020 BUSINESS PHONE: 2159381661 MAIL ADDRESS: STREET 1: 3220 TILLMAN DRIVE STREET 2: SUITE 300 CITY: BENSALEM STATE: PA ZIP: 19020 4 1 wf-form4_135767570749059.xml FORM 4 X0306 4 2012-12-31 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0001502211 SHEA JOHN CHRISTOPHER 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 0 1 0 0 Chief Financial Officer Common Stock 2012-12-31 4 A 0 1412 15.04 A 1412 D Restricted Stock 2013-01-04 4 A 0 350 0 A 350 D Phantom Stock 0.0 2012-12-31 4 A 0 534 23.23 A 2012-12-31 Common Stock 534.0 534 D Stock Option (right to buy) 23.5 2013-01-04 4 A 0 5000 0 A 2018-01-04 2023-01-04 Common Stock 5000.0 5000 D Acquired in 2013 by the Reporting Person through participation in the 2012 Healthcare Services Group, Inc. Employee Stock Purchase Plan. Represents shares of Restricted Stock Awards granted to the Reporting Person, pursuant to the Healthcare Services Group, Inc. 2012 Equity Incentive Plan. Shares issued at conversion rate of 1-for-1 basis. Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan. Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer. These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary from the date set forth in Table II, Column 3. /s/ John C. Shea 2013-01-08