0000731012-21-000014.txt : 20210106 0000731012-21-000014.hdr.sgml : 20210106 20210106185254 ACCESSION NUMBER: 0000731012-21-000014 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210104 FILED AS OF DATE: 20210106 DATE AS OF CHANGE: 20210106 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WAHL Theodore CENTRAL INDEX KEY: 0001454244 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 21512296 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_160997715917471.xml FORM 4 X0306 4 2021-01-04 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0001454244 WAHL Theodore 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 1 1 0 0 President & CEO Common Stock 2021-01-04 4 A 0 1025 20.67 A 216668 D Common Stock 2021-01-04 4 M 0 6000 0 A 222668 D Common Stock 2021-01-04 4 M 0 6000 0 A 228668 D Common Stock 2021-01-04 4 M 0 8500 0 A 237168 D Common Stock 2021-01-04 4 M 0 15548 0 A 252716 D Common Stock 2021-01-04 4 F 0 14302 0 D 238414 D Phantom Stock 2021-01-04 4 A 0 2219 28.10 A Common Stock 2219.0 18228 D Stock Option (right to buy) 28.37 2021-01-04 4 A 0 103193 28.37 A 2031-01-04 Common Stock 103193.0 103193 D Restricted Stock Units 2021-01-04 4 A 0 50123 0 A Common Stock 50123.0 50123 D Restricted Stock Units 2021-01-04 4 M 0 6000 0 D Common Stock 6000.0 6000 D Restricted Stock Units 2021-01-04 4 M 0 6000 0 D Common Stock 6000.0 12000 D Restricted Stock Units 2021-01-04 4 M 0 8500 0 D Common Stock 8500.0 25500 D Restricted Stock Units 2021-01-04 4 M 0 15548 0 D Common Stock 15548.0 62188 D Acquired by the Reporting Person through participation in the Healthcare Services Group, Inc. Employee Stock Purchase Plan. Total direct and indirect beneficial ownership by reporting person is 359,876 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 options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2021 grant date. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2021 grant date. These Restricted Stock Units shall vest 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 at the rate of 20% annually, commencing on the first anniversary of the January 4, 2019 grant date. These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 3, 2020 grant date. /s/ John C. Shea 2021-01-06 EX-24 2 wahlpoa7_10x2012-v2.htm THEODORE WAHL POA 7-10-2012

POWER OF ATTORNEY

Know all by these presents that the undersigned hereby constitutes and appoints each of John Shea and
Michael Harrity 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
10th day of July, 2012.



Signature /s/ Theodore Wahl

Print Name Theodore Wahl