0000731012-20-000026.txt : 20200106 0000731012-20-000026.hdr.sgml : 20200106 20200106210504 ACCESSION NUMBER: 0000731012-20-000026 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20200102 FILED AS OF DATE: 20200106 DATE AS OF CHANGE: 20200106 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kush Andrew CENTRAL INDEX KEY: 0001704092 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 20511911 MAIL ADDRESS: STREET 1: 3220 TILLMAN DRIVE STREET 2: SUITE 300 CITY: BENSALEM STATE: PA ZIP: 19020 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HEALTHCARE SERVICES GROUP INC CENTRAL INDEX KEY: 0000731012 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-NURSING & PERSONAL CARE FACILITIES [8050] IRS NUMBER: 232018365 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3220 TILLMAN DRIVE STREET 2: SUITE 300 CITY: BENSALEM STATE: PA ZIP: 19020 BUSINESS PHONE: 2159381661 MAIL ADDRESS: STREET 1: 3220 TILLMAN DRIVE STREET 2: SUITE 300 CITY: BENSALEM STATE: PA ZIP: 19020 4 1 wf-form4_157836268410747.xml FORM 4 X0306 4 2020-01-02 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0001704092 Kush Andrew 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 0 1 0 0 Executive Vice President Common Stock 2020-01-04 4 M 0 1700 0 A 6150 D Common Stock 2020-01-04 4 M 0 1200 0 A 7350 D Common Stock 2020-01-04 4 M 0 1700 0 A 9050 D Common Stock 2020-01-04 4 M 0 200 0 A 9250 D Common Stock 2020-01-05 4 M 0 125 0 A 9375 D Common Stock 2020-01-05 4 F 0 1590 0 D 7785 D Phantom Stock 2020-01-02 4 A 0 905 24.32 A Common Stock 905.0 3547 D Restricted Stock Units 2020-01-03 4 A 0 14088 0 A Common Stock 14088.0 14088 D Stock Option (right to buy) 24.43 2020-01-03 4 A 0 17721 0 A 2030-01-03 Common Stock 17721.0 17721 D Restricted Stock Units 2020-01-04 4 M 0 1700 0 D Common Stock 1700.0 3400 D Restricted Stock Units 2020-01-04 4 M 0 1200 0 D Common Stock 1200.0 3600 D Restricted Stock Units 2020-01-04 4 M 0 1700 0 D Common Stock 1700.0 6800 D Restricted Stock 2020-01-04 4 M 0 200 0 D Common Stock 200.0 200 D Restricted Stock 2020-01-05 4 M 0 125 0 D Common Stock 125.0 0 D Shares issued at the conversion rate of 1-for-1. Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer. Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 3, 2020 grant date. These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 3, 2020 grant date. These 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. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2018 grant date. These Restricted Stock Units shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 3, 2020 grant date. These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2016 grant date. This 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. These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 5, 2015 grant date. John C. Shea, by Power of Attorney 2020-01-06 EX-24 2 poa.htm KUSH ANDREW POWER OF ATTORNEY

POWER OF ATTORNEY

Know all by these presents that the undersigned hereby constitutes and appoints each of John Shea, Michael Harrity and Bobbi Jo Flannick signing singly, as the undersigned's true and lawful attorneys-in-fact to:

1)    execute for and on behalf of the undersigned Forms 3, 4 and 5 in accordance with Section 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act") relating to Healthcare Services Group, Inc. (the "Company");

2)    do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Forms 3, 4 or 5, complete and execute any amendment or amendments thereto, and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and

3)    take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-fact's discretion.

The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that each such attorney-in-fact, or each such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted.  The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming any of the undersigned's responsibilities to comply with Section 16 of the Exchange Act.  The undersigned acknowledges that such attorney-in-fact is not assuming: (i) any liability for the undersigned's responsibility to comply with the requirements of the Act; (ii) any liability of the undersigned for any failure to comply with such requirements; or (iii) any obligation or liability of the undersigned for profit disgorgement under Section 16(b) of the Act.

This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 11th day of April, 2017.



Signature /s/ Andrew Kush

Print Name  Andrew Kush