0001209191-12-002643.txt : 20120106 0001209191-12-002643.hdr.sgml : 20120106 20120106200526 ACCESSION NUMBER: 0001209191-12-002643 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120105 FILED AS OF DATE: 20120106 DATE AS OF CHANGE: 20120106 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McBryan Michael E CENTRAL INDEX KEY: 0001521830 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 12515804 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 X0304 4 2012-01-05 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0001521830 McBryan Michael E 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 1 1 0 0 Sr VP of Operations Common stock 7174 D Phantom stock 0.00 2012-01-05 4 A 0 1479 17.69 A 2012-01-05 common stock 1479 1479 D Stock option 17.50 2012-01-05 4 A 0 3000 0.00 A 2013-01-05 2022-01-05 common stock 3000 3000 D Stock option 17.50 2012-01-05 4 A 0 3000 0.00 A 2014-01-05 2022-01-05 common stock 3000 6000 D Stock option 17.50 2012-01-05 4 A 0 3000 0.00 A 2015-01-05 2022-01-05 common stock 3000 9000 D Stock option 17.50 2012-01-05 4 A 0 3000 0.00 A 2016-01-05 2022-01-05 common stock 3000 12000 D Stock option 17.50 2012-01-05 4 A 0 3000 0.00 A 2017-01-05 2022-01-05 common stock 3000 15000 D INCLUDES 1,085 SHARES ISSUED IN 2012 PURSUANT TO 2011 EMPLOYEE STOCK PURCHASE PLAN PARTICIPATION PAYMENTS AT AN OFFERING PRICE OF $13.83 PER COMMON SHARE. 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/ Michael E. McBryan 2012-01-05