0001209191-12-051665.txt : 20121105
0001209191-12-051665.hdr.sgml : 20121105
20121105130301
ACCESSION NUMBER: 0001209191-12-051665
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20121102
FILED AS OF DATE: 20121105
DATE AS OF CHANGE: 20121105
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Ottaviano Dino D
CENTRAL INDEX KEY: 0001403593
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-12015
FILM NUMBER: 121179314
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
X0306
4
2012-11-02
0
0000731012
HEALTHCARE SERVICES GROUP INC
HCSG
0001403593
Ottaviano Dino D
3220 TILLMAN DRIVE
SUITE 300
BENSALEM
PA
19020
1
0
0
0
Common Stock
2012-11-02
4
M
0
1501
14.3067
A
1791
D
Common Stock
2012-11-02
4
S
0
1501
24.0318
D
290
D
Stock Option
14.3067
2012-11-02
4
M
0
1501
0.00
D
2012-01-04
2020-01-04
Common Stock
1501
0
D
/S/ Michael Harrity, by Power of Attorney
2012-11-05
EX-24.4_443230
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents that the undersigned hereby constitutes and appoints
each of John Shea and Michael Harrity signing singly, as the undersigned's true
and lawful attorneys-in-fact to:
1) execute for and on behalf of the undersigned Forms 3, 4 and 5 in accordance
with Section 16 of the Securities Exchange Act of 1934, as amended (the
"Exchange Act") relating to Healthcare Services Group, Inc. (the "Company");
2) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Forms 3, 4 or 5,
complete and execute any amendment or amendments thereto, and timely file such
form with the United States Securities and Exchange Commission and any stock
exchange or similar authority; and
3) take any other action of any type whatsoever in connection with the foregoing
which, in the opinion of such attorney-in-fact, may be of benefit to, in the
best interest of, or legally required by, the undersigned, it being understood
that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that each such attorney-in-fact, or each
such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to
be done by virtue of this power of attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming any
of the undersigned's responsibilities to comply with Section 16 of the Exchange
Act. The undersigned acknowledges that such attorney-in-fact is not assuming:
(i) any liability for the undersigned's responsibility to comply with the
requirements of the Act; (ii) any liability of the undersigned for any failure
to comply with such requirements; or (iii) any obligation or liability of the
undersigned for profit disgorgement under Section 16(b) of the Act.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 10th day of July, 2012.
SIGNATURE
/S/ Dino D. Ottaviano
Dino D. Ottaviano