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