SEC Form 4 · accession 0000731012-17-000024
HEALTHCARE SERVICES GROUP INC · HCSG
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael E McBryan
Officer — Executive Vice President · Director
Period of report
Dec 31, 2016
Accepted (ET)
Jan 4, 2017 · 8:49 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 | Dec 31, 2016 | A | 505 | $29.64 | A | 18,575 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F2 | $39.38 | Jan 4, 2017 | A | 15,000 | A | Jan 4, 2022 | Jan 4, 2027 | Common Stock | 15,000 | 15,000 | D |
| Restricted Stock UnitsF3,F4 | — | Jan 4, 2017 | A | 3,125 | A | Jan 4, 2022 | — | Common Stock | 3,125 | 3,125 | D |
| Phantom StockF5,F3,F6 | — | Dec 31, 2016 | A | 949 | A | Dec 31, 2016 | — | Common Stock | 949 | 949 | D |
Explanation of responses
- F1Acquired by the Reporting Person through participation in the Healthcare Services Group, Inc. Employee Stock Purchase Plan.
- F2These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2017 grant date.
- F3Shares issued at the conversion rate of 1-for-1.
- F4These Restricted Stock Units shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2017 grant date.
- F5Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan.
- F6Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer.