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