1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Phantom Stock
(1)
|
Â
(2)
|
Â
(2)
|
Common Stock
|
5,848
|
$
0
|
D
|
Â
|
Restricted Stock
|
Â
(3)
|
Â
(3)
|
Common Stock
|
70
|
$
0
|
D
|
Â
|
Restricted Stock
|
Â
(4)
|
Â
(4)
|
Common Stock
|
250
|
$
0
|
D
|
Â
|
Restricted Stock
|
Â
(5)
|
Â
(5)
|
Common Stock
|
675
|
$
0
|
D
|
Â
|
Restricted Stock
|
Â
(6)
|
Â
(6)
|
Common Stock
|
1,200
|
$
0
|
D
|
Â
|
Restricted Stock Units
|
Â
(7)
|
Â
(7)
|
Common Stock
|
1,500
|
$
0
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(8)
|
01/04/2023 |
Common Stock
|
5,000
|
$
23.5
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(9)
|
01/03/2024 |
Common Stock
|
6,250
|
$
28.02
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(10)
|
01/05/2025 |
Common Stock
|
7,500
|
$
30.3
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(11)
|
01/04/2026 |
Common Stock
|
7,500
|
$
34.14
|
D
|
Â
|
Stock Option (right to buy)
|
Â
(12)
|
01/04/2027 |
Common Stock
|
7,500
|
$
39.38
|
D
|
Â
|
* |
If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) |
Acquired pursuant to an Issuer contribution under the Healthcare Services Group, Inc. Deferred Compensation Plan. |
(2) |
Shares of Phantom Stock are payable in-kind following termination of the Reporting Person's employment with Issuer. |
(3) |
These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2013 grant date, and as such, 280 of these awards have already vested. |
(4) |
These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 3, 2014 grant date, and as such, 375 of these awards have already vested. |
(5) |
These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 5, 2015 grant date, and as such, 450 of these awards have already vested. |
(6) |
These Restricted Stock Awards shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2016 grant date, and as such, 300 of these awards have already vested. |
(7) |
These Restricted Stock Units shall vest at the rate of 20% annually, commencing on the first anniversary of the January 4, 2017 grant date. |
(8) |
These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2013 grant date. |
(9) |
These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 3, 2014 grant date. |
(10) |
These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 5, 2015 grant date. |
(11) |
These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2016 grant date. |
(12) |
These options shall vest and become exercisable at the rate of 20% annually, commencing on the first anniversary of the January 4, 2017 grant date. |