SEC Form 4 · accession 0000731012-19-000027
HEALTHCARE SERVICES GROUP INC · HCSG
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jason J Bundick
Officer — General Counsel & Secretary
Period of report
Jan 2, 2019
Accepted (ET)
Jan 4, 2019 · 6:30 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 4, 2019 | M | 1,700 | $0.00 | A | 4,891 | D | |
| Common Stock | Jan 4, 2019 | M | 1,200 | $0.00 | A | 6,091 | D | |
| Common Stock | Jan 4, 2019 | F | 949 | $0.00 | D | 5,142 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Phantom StockF2,F1,F3 | — | Jan 2, 2019 | A | 146 | A | — | — | Common Stock | 146 | 1,037 | D |
| Restricted Stock UnitsF1,F4 | — | Jan 4, 2019 | M | 1,700 | D | — | — | Common Stock | 1,700 | 5,100 | D |
| Restricted Stock UnitsF1,F5 | — | Jan 4, 2019 | M | 1,200 | D | — | — | Common Stock | 1,200 | 4,800 | D |
| Restricted Stock UnitsF1,F6 | — | Jan 4, 2019 | A | 8,500 | A | — | — | Common Stock | 8,500 | 8,500 | D |
| Stock Option (right to buy)F7 | $40.49 | Jan 4, 2019 | A | 10,000 | A | — | Jan 4, 2029 | Common Stock | 10,000 | 10,000 | D |
Explanation of responses
- F1Shares issued at the conversion rate of 1-for-1.
- F2Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan.
- F3Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer.
- 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.
- F5These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2018 grant date.
- F6These Restricted Stock Units shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2019 grant date.
- F7These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2019 grant date.