SEC FORM 3

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Orr Patrick J

(Last)

(First)

(Middle)

3220 TILLMAN DRIVE

SUITE 300

(Street)

BENSALEM

19020

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
01/01/2021

3. Issuer Name and Ticker or Trading Symbol
HEALTHCARE SERVICES GROUP INC [ HCSG ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
	EVP & Chief Revenue Officer

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	3,357	D

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Phantom Stock⁽¹⁾	⁽²⁾	⁽²⁾	Common Stock	1,041	$0.0	D
Restricted Stock Units	⁽³⁾	⁽³⁾	Common Stock	1,500	$0.0	D
Restricted Stock Units	⁽⁴⁾	⁽⁴⁾	Common Stock	600	$0.0	D
Restricted Stock Units	⁽⁵⁾	⁽⁵⁾	Common Stock	3,080	$0.0	D
Restricted Stock Units	⁽⁶⁾	⁽⁶⁾	Common Stock	6,445	$0.0	D
Stock Option (right to buy)	⁽⁷⁾	01/05/2025	Common Stock	800	$30.3	D
Stock Option (right to buy)	⁽⁸⁾	01/04/2026	Common Stock	2,400	$34.14	D
Stock Option (right to buy)	⁽⁹⁾	01/04/2027	Common Stock	4,000	$39.38	D
Stock Option (right to buy)	⁽¹⁰⁾	01/04/2028	Common Stock	5,000	$52.06	D
Stock Option (right to buy)	⁽¹¹⁾	01/04/2029	Common Stock	5,000	$40.49	D
Stock Option (right to buy)	⁽¹²⁾	01/03/2030	Common Stock	8,523	$24.43	D

Explanation of Responses:

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 Units vest at the rate of 20% annually, commencing on each calendar anniversary after the award's January 4, 2017 grant date, and as such, 2,250 of these awards have already vested.

4. These Restricted Stock Units vest at the rate of 20% annually, commencing on each calendar anniversary after the award's January 4, 2018 grant date, and as such, 400 of these awards have already vested.

5. These Restricted Stock Units vest at the rate of 20% annually, commencing on each calendar anniversary after the award's January 4, 2019 grant date, and as such, 770 of these awards have already vested.

6. These Restricted Stock Units vest at the rate of 20% annually, commencing on each calendar anniversary after the award's January 3, 2020 grant date.

7. These options have fully vested.

8. These options shall vest and become exercisable at the rate of 20% annually, commencing on each calendar anniversary of the option's January 4, 2016 grant date, and as such, 1,600 of these options have already vested and are exercisable.

9. These options shall vest and become exercisable at the rate of 20% annually, commencing on each calendar anniversary of the option's January 4, 2017 grant date, and as such, 2,000 of these options have already vested and are exercisable.

10. These options shall vest and become exercisable at the rate of 20% annually, commencing on each calendar anniversary of the option's January 4, 2018 grant date, and as such, 2,000 of these options have already vested and are exercisable.

11. These options shall vest and become exercisable at the rate of 20% annually, commencing on each calendar anniversary of the option's January 4, 2019 grant date, and as such, 1,000 of these options have already vested and are exercisable.

12. These options shall vest and become exercisable at the rate of 20% annually, commencing on each calendar anniversary of the option's January 3, 2020 grant date.

Remarks:

	John C. Shea, by Power of Attorney	01/04/2021
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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