-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, LN8euFV3t2JR3AvhVYd3y5zPUKgwokAbW5S+rMe0ZIXuOWvNyI6b2FO8Da5wO5Mk A0rvlMlFRdbgLv9oS5MqUA== 0001209191-11-002510.txt : 20110107 0001209191-11-002510.hdr.sgml : 20110107 20110107172903 ACCESSION NUMBER: 0001209191-11-002510 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110105 FILED AS OF DATE: 20110107 DATE AS OF CHANGE: 20110107 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WAHL Theodore CENTRAL INDEX KEY: 0001454244 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 11518389 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: 2643 HUNTINGDON PIKE CITY: HUNTINGDON VALLEY STATE: PA ZIP: 19006 BUSINESS PHONE: 2159381661 MAIL ADDRESS: STREET 1: 2643 HUNTINGDON PIKEE CITY: HUNTINGDON VALLEY STATE: PA ZIP: 19006 4 1 doc4.xml FORM 4 SUBMISSION X0303 4 2011-01-05 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0001454244 WAHL Theodore 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 0 1 0 0 Executive Vice President Phantom stock 0.00 2011-01-05 4 A 0 1009 16.27 A 2011-01-05 common stock 1009 1009 D Stock option 16.11 2011-01-06 4 A 0 3000 0.00 A 2012-01-06 2021-01-06 common stock 3000 3000 D Stock option 16.11 2011-01-06 4 A 0 3000 0.00 A 2013-01-06 2021-01-06 common stock 3000 6000 D Stock option 16.11 2011-01-06 4 A 0 3000 0.00 A 2014-01-06 2021-01-06 common stock 3000 9000 D Stock option 16.11 2011-01-06 4 A 0 3000 0.00 A 2015-01-06 2021-01-06 common stock 3000 12000 D Stock option 16.11 2011-01-06 4 A 0 3000 0.00 A 2016-01-06 2021-01-06 common stock 3000 15000 D SHARES ISSUED AT CONVERSION RATE OF 1 FOR 1 ACQUIRED PURSANT 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 /s/ Theodore Wahl 2011-01-07 -----END PRIVACY-ENHANCED MESSAGE-----