SEC Form 4 · accession 0000731012-16-000108
HEALTHCARE SERVICES GROUP INC · HCSG
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
John Christopher Shea
Officer — Chief Financial Officer
Period of report
Dec 31, 2015
Accepted (ET)
Jan 5, 2016 · 4:47 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000731012
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jan 4, 2016 | A | 2,150 | $0.00 | A | 6,187 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Phantom StockF3,F2,F4 | $0.00 | Dec 31, 2015 | A | 484 | A | Dec 31, 2015 | — | Common Stock | 484 | 484 | D |
| Stock Option (right to buy)F5 | $34.14 | Jan 4, 2016 | A | 1,650 | A | Jan 4, 2021 | Jan 4, 2026 | Common Stock | 1,650 | 1,650 | D |
Explanation of responses
- F1Represents shares of Restricted Stock Awards granted to the Reporting Person, pursuant to the Healthcare Services Group, Inc. 2012 Equity Incentive Plan.
- F2Shares issued at conversion rate of 1-for-1 basis.
- F3Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan.
- F4Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer.
- F5These 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.