0000731012-22-000018.txt : 20220106 0000731012-22-000018.hdr.sgml : 20220106 20220106120635 ACCESSION NUMBER: 0000731012-22-000018 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220103 FILED AS OF DATE: 20220106 DATE AS OF CHANGE: 20220106 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHEA JOHN CHRISTOPHER CENTRAL INDEX KEY: 0001502211 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 22514172 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-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 4/A 1 wf-form4a_164148878303969.xml FORM 4/A X0306 4/A 2022-01-03 2022-01-05 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0001502211 SHEA JOHN CHRISTOPHER 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 0 1 0 0 EVP & Chief Admin Officer Common Stock 2022-01-03 4 A 0 889 15.12 A 18091 D Common Stock 2022-01-03 4 M 0 2819 0 A 20910 D Common Stock 2022-01-04 4 M 0 1930 0 A 22840 D Common Stock 2022-01-04 4 M 0 1200 0 A 24040 D Common Stock 2022-01-04 4 M 0 1700 0 A 25740 D Common Stock 2022-01-04 4 M 0 2002 0 A 27742 D Common Stock 2022-01-04 4 F 0 3770 0 D 23972 D Phantom Stock 2022-01-03 4 A 0 1530 17.79 A Common Stock 1530.0 8189 D Restricted Stock Units 2022-01-03 4 M 0 2819 0 D Common Stock 2819.0 8450 D Stock Option (right to buy) 18.1 2022-01-04 4 A 0 36974 18.10 A 2032-01-04 Common Stock 36974.0 36974 D Restricted Stock Units 2022-01-04 4 A 0 16587 0 A Common Stock 16587.0 16587 D Restricted Stock Units 2022-01-04 4 M 0 1930 0 D Common Stock 1930.0 0 D Restricted Stock Units 2022-01-04 4 M 0 1200 0 D Common Stock 1200.0 1200 D Restricted Stock Units 2022-01-04 4 M 0 1700 0 D Common Stock 1700.0 3400 D Restricted Stock Units 2022-01-04 4 M 0 2002 0 D Common Stock 2002.0 8009 D The original Form 4, filed on January 5, 2022, is being amended solely to correct Mr. Shea's officer title in box 5. As announced on August 24, 2021, Mr. Shea was appointed EVP & Chief Administrative Officer. Acquired by the Reporting Person through participation in the Healthcare Services Group, Inc. Employee Stock Purchase Plan. Shares issued at the conversion rate of 1-for-1. Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 3, 2020 grant date. These Options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2022 grant date. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2022 grant date. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2017 grant date. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2018 grant date. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2019 grant date. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2021 grant date. /s/ Michael Harrity, by Power of Attorney 2022-01-06