0000731012-23-000094.txt : 20230703 0000731012-23-000094.hdr.sgml : 20230703 20230703193003 ACCESSION NUMBER: 0000731012-23-000094 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230630 FILED AS OF DATE: 20230703 DATE AS OF CHANGE: 20230703 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FROME ROBERT L CENTRAL INDEX KEY: 0000946426 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 231066367 MAIL ADDRESS: STREET 1: 3220 TILLMAN DRIVE 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 wk-form4_1688426994.xml FORM 4 X0407 4 2023-06-30 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0000946426 FROME ROBERT L 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 1 0 0 0 1 Common Stock 2023-06-30 4 A 0 168 14.93 A 21729 D The reporting person has elected to receive fully vested shares of Deferred Stock Units ("DSUs") under the Issuer's 2020 Omnibus Incentive Plan, as amended, in lieu of cash fees payable for service on the Issuer's Board of Directors and any committees thereof. The reporting person made this election in November 2022 which applies to director's fees earned in 2023 in compliance with the Issuer's black-out period guidelines. The number of shares represents the quotient of the amount of such fees divided by the Issuer's closing stock price on the date such fees would otherwise be paid, rounded up to the nearest whole share. Such DSUs will be settled in shares of common stock ninety days following separation of service from the Board. The reporting person may elect a further deferral beyond the Settlement Date pursuant to the rules of Code Section 409A. Amount represents 2,835 unvested DSUs, 3,986 vested DSUs, and 14,908 shares of common stock. /s/ Michael Harrity, by Power of Attorney 2023-07-03