SEC Form 4 · accession 0000731012-18-000013
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
Jan 2, 2018
Accepted (ET)
Jan 4, 2018 · 7:41 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 Stock | Jan 4, 2018 | M | 1,930 | $0.00 | A | 8,117 | D | |
| Common Stock | Jan 4, 2018 | F | 550 | $0.00 | D | 7,567 | 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)F1 | $52.06 | Jan 4, 2018 | A | 10,000 | A | — | Jan 4, 2028 | Common Stock | 10,000 | 10,000 | D |
| Restricted Stock UnitsF2,F3 | — | Jan 4, 2018 | A | 6,000 | A | — | — | Common Stock | 6,000 | 6,000 | D |
| Restricted Stock UnitsF2,F4 | — | Jan 4, 2018 | M | 1,930 | D | — | — | Common Stock | 1,930 | 7,720 | D |
| Phantom StockF5,F2,F6 | — | Jan 2, 2018 | A | 356 | A | — | — | Common Stock | 356 | 3,907 | D |
Explanation of responses
- F1These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2018 grant date.
- F2Shares issued at the conversion rate of 1-for-1.
- F3These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2018 grant date.
- 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.