0000731012-23-000113.txt : 20231003 0000731012-23-000113.hdr.sgml : 20231003 20231003105328 ACCESSION NUMBER: 0000731012-23-000113 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230930 FILED AS OF DATE: 20231003 DATE AS OF CHANGE: 20231003 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Simmons Kurt JR CENTRAL INDEX KEY: 0001890359 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12015 FILM NUMBER: 231301984 MAIL ADDRESS: STREET 1: 3220 TILLMAN DRIVE 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_1696344798.xml FORM 4 X0508 4 2023-09-30 0 0000731012 HEALTHCARE SERVICES GROUP INC HCSG 0001890359 Simmons Kurt JR 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 1 0 0 0 1 Common Stock 2023-09-30 4 A 0 1439 10.43 A 9981 D The reporting person has elected to receive fully vested shares of Deferred Stock Units ("DSUs") under the Issuer's 2020 Omnibus Incentive Plan 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 on the first to occur of (i) January 1, 2029; (ii) the Participant's date of death, disability or separation from service; or (iii) the date of a Change of Control (the "Settlement Date"). 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 and 7,146 vested DSUs. /s/ Michael Harrity, by Power of Attorney 2023-10-03