0000731012-21-000015.txt : 20210106 0000731012-21-000015.hdr.sgml : 20210106 20210106185313 ACCESSION NUMBER: 0000731012-21-000015 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: Orr Patrick J CENTRAL INDEX KEY: 0001835033 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 21512300 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_160997717703650.xml FORM 4 X0306 4 2021-01-04 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0001835033 Orr Patrick J 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 0 1 0 0 EVP & Chief Revenue Officer Common Stock 2021-01-04 4 A 0 769 20.67 A 4126 D Common Stock 2021-01-04 4 M 0 750 0 A 4876 D Common Stock 2021-01-04 4 M 0 200 0 A 5076 D Common Stock 2021-01-04 4 M 0 770 0 A 5846 D Common Stock 2021-01-04 4 M 0 1290 0 A 7136 D Common Stock 2021-01-04 4 F 0 1343 0 D 5793 D Phantom Stock 2021-01-04 4 A 0 700 28.10 A Common Stock 700.0 1748 D Stock Option (right to buy) 28.37 2021-01-04 4 A 0 15421 28.37 A 2031-01-04 Common Stock 15421.0 15421 D Restricted Stock Units 2021-01-04 4 A 0 7490 0 A Common Stock 7490.0 7490 D Restricted Stock Units 2021-01-04 4 M 0 750 0 D Common Stock 750.0 750 D Restricted Stock Units 2021-01-04 4 M 0 200 0 D Common Stock 200.0 400 D Restricted Stock Units 2021-01-04 4 M 0 770 0 D Common Stock 770.0 2310 D Restricted Stock Units 2021-01-04 4 M 0 1290 0 D Common Stock 1290.0 5155 D Acquired by the Reporting Person through participation in the Healthcare Services Group, Inc. Employee Stock Purchase Plan. Shares issued at the conversion rate of 1-for-1. Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan. Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer. 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. 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 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. John C. Shea, by Power of Attorney 2021-01-06 EX-24 2 orr_poa.htm ORR PATRICK J 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 Andrew Brophy 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 25th day of November 2020.

Signature: /s/ Patrick Orr




Print Name:  Patrick Orr