0000731012-16-000102.txt : 20160105
0000731012-16-000102.hdr.sgml : 20160105
20160105164536
ACCESSION NUMBER: 0000731012-16-000102
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20160104
FILED AS OF DATE: 20160105
DATE AS OF CHANGE: 20160105
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: HEALTHCARE SERVICES GROUP INC
CENTRAL INDEX KEY: 0000731012
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-NURSING & PERSONAL CARE FACILITIES [8050]
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Visconto Jude
CENTRAL INDEX KEY: 0001645229
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-12015
FILM NUMBER: 161322956
MAIL ADDRESS:
STREET 1: 3220 TILLMAN DRIVE
STREET 2: SUITE 300
CITY: BENSALEM
STATE: PA
ZIP: 19020
4
1
wf-form4_145203032085983.xml
FORM 4
X0306
4
2016-01-04
0
0000731012
HEALTHCARE SERVICES GROUP INC
HCSG
0001645229
Visconto Jude
3220 TILLMAN DRIVE
SUITE 300
BENSALEM
PA
19020
1
0
0
0
Stock Option (right to buy)
34.14
2016-01-04
4
A
0
5001
0
A
2021-01-04
2026-01-04
Common Stock
5001.0
5001
D
/s/ Jonathan Gregory, by Power of Attorney
2016-01-04
EX-24
2
viscontopoa6_12x2015.txt
JUDE VISCONTO POA 6-12-2015
POWER OF ATTORNEY
Know all by these presents that the undersigned hereby constitutes
and appoints each of John Shea, Jonathan Gregory and Michael Harrity signing
singly, as the undersigned's true and lawful attorneys-in-fact to:
1) execute for and on behalf of the undersigned Forms 3, 4 and 5 in accordance
with Section 16 of the Securities Exchange Act of 1934, as amended
(the "Exchange Act") relating to Healthcare Services Group, Inc. (the
"Company");
2) do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such
Forms 3, 4 or 5, complete and execute any amendment or amendments thereto,
and timely file such form with the United States Securities and Exchange
Commission and any stock exchange or similar authority; and
3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit
to, in the best interest of, or legally required by, the undersigned, it
being understood that the documents executed by such attorney-in-fact on
behalf of the undersigned pursuant to this Power of Attorney shall be in
such form and shall contain such terms and conditions as such attorney-in
-fact may approve in such attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full
power and authority to do and perform any and every act and thing
whatsoever requisite, necessary, or proper to be done in the exercise of
any of the rights and powers herein granted, as fully to all intents and
purposes as the undersigned might or could do if personally present, with
full power of substitution or revocation, hereby ratifying and confirming
all that each such attorney-in-fact, or each such attorney-in-fact's
substitute or substitutes, shall lawfully do or cause to be done by virtue
of this power of attorney and the rights and powers herein granted. The
undersigned acknowledges that the foregoing attorneys-in-fact, in serving
in such capacity at the request of the undersigned, are not assuming any
of the undersigned's responsibilities to comply with Section 16 of the
Exchange Act. The undersigned acknowledges that such attorney-in-fact
is not assuming: (i) any liability for the undersigned's responsibility
to comply with the requirements of the Act; (ii) any liability of the
undersigned for any failure to comply with such requirements; or (iii)
any obligation or liability of the undersigned for profit disgorgement
under Section 16(b) of the Act.
This Power of Attorney shall remain in full force and effect
until the undersigned is no longer required to file Forms 3, 4 and 5
with respect to the undersigned's holdings of and transactions in
securities issued by the Company, unless earlier revoked by the
undersigned in a signed writing delivered to the foregoing attorneys
-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of
Attorney to be executed as of this 12th day of June, 2015.
Signature /s/ Jude Visconto
Print Name Jude Visconto