0000731012-16-000108.txt : 20160105 0000731012-16-000108.hdr.sgml : 20160105 20160105164724 ACCESSION NUMBER: 0000731012-16-000108 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151231 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: SHEA JOHN CHRISTOPHER CENTRAL INDEX KEY: 0001502211 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 161322996 MAIL ADDRESS: STREET 1: 3220 TILLMAN DRIVE STREET 2: SUITE 300 CITY: BENSALEM STATE: PA ZIP: 19020 4 1 wf-form4_145203043423253.xml FORM 4 X0306 4 2015-12-31 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 2016-01-04 4 A 0 2150 0 A 6187 D Phantom Stock 0.0 2015-12-31 4 A 0 484 34.87 A 2015-12-31 Common Stock 484.0 484 D Stock Option (right to buy) 34.14 2016-01-04 4 A 0 1650 0 A 2021-01-04 2026-01-04 Common Stock 1650.0 1650 D 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 2016-01-05