SEC Form 4 · accession 0000731012-18-000023
HEALTHCARE SERVICES GROUP INC · HCSG
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
David Hurlock
Officer — Executive Vice President & COO
Period of report
Jan 2, 2018
Accepted (ET)
Jan 4, 2018 · 9:30 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 2, 2018 | A | 195 | $33.29 | A | 4,079 | D | |
| Common Stock | Jan 4, 2018 | F | 85 | $0.00 | D | 3,994 | D | |
| Common Stock | Jan 3, 2018 | M | 125 | $0.00 | A | 4,119 | D | |
| Common Stock | Jan 4, 2018 | M | 70 | $0.00 | A | 4,189 | D | |
| Common Stock | Jan 4, 2018 | M | 300 | $0.00 | A | 4,489 | D | |
| Common Stock | Jan 4, 2018 | M | 300 | $0.00 | A | 4,789 | D | |
| Common Stock | Jan 5, 2018 | M | 225 | $0.00 | A | 5,014 | 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 | 300 | D | — | — | Common Stock | 300 | 1,200 | D |
| Restricted StockF6,F2,F5 | — | Jan 3, 2018 | M | 125 | D | — | — | Common Stock | 125 | 125 | D |
| Restricted StockF6,F2,F7 | — | Jan 4, 2018 | M | 70 | D | — | — | Common Stock | 70 | 0 | D |
| Restricted StockF6,F2,F8 | — | Jan 4, 2018 | M | 300 | D | — | — | Common Stock | 300 | 900 | D |
| Restricted StockF6,F2,F9 | — | Jan 5, 2018 | M | 225 | D | — | — | Common Stock | 225 | 450 | D |
| Phantom StockF10,F2,F11 | — | Jan 2, 2018 | A | 331 | A | — | — | Common Stock | 331 | 6,179 | 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.
- F10Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan.
- F11Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer.
- 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 at the rate of 20% annually, commencing on the first anniversary of the January 4, 2017 grant date.
- F5These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 3, 2014 grant date.
- F6This grant was made prior to the Reporting Person becoming a Section 16(a) filer, and as of the date of filing, a portion of this grant has already vested.
- F7These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2013 grant date.
- F8These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2016 grant date.
- F9These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 5, 2015 grant date.