0001209191-16-091825.txt : 20160115
0001209191-16-091825.hdr.sgml : 20160115
20160115174528
ACCESSION NUMBER: 0001209191-16-091825
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20151231
FILED AS OF DATE: 20160115
DATE AS OF CHANGE: 20160115
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Alliance HealthCare Services, Inc
CENTRAL INDEX KEY: 0000817135
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071]
IRS NUMBER: 330239910
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 100 BAYVIEW CIRCLE
STREET 2: SUITE 400
CITY: NEWPORT BEACH
STATE: CA
ZIP: 92660
BUSINESS PHONE: 949-242-5300
MAIL ADDRESS:
STREET 1: 100 BAYVIEW CIRCLE
STREET 2: SUITE 400
CITY: NEWPORT BEACH
STATE: CA
ZIP: 92660
FORMER COMPANY:
FORMER CONFORMED NAME: ALLIANCE IMAGING INC /DE/
DATE OF NAME CHANGE: 19930328
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bartos Scott A.
CENTRAL INDEX KEY: 0001561067
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-16609
FILM NUMBER: 161346501
MAIL ADDRESS:
STREET 1: 450 KNIGHTS RUN, #1604
CITY: TAMPA
STATE: FL
ZIP: 33602
FORMER NAME:
FORMER CONFORMED NAME: Bartos Scott A
DATE OF NAME CHANGE: 20121025
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-12-31
0
0000817135
Alliance HealthCare Services, Inc
AIQ
0001561067
Bartos Scott A.
C/O ALLIANCE HEALTHCARE SERVICES, INC.
100 BAYVIEW CIRCLE, SUITE 400
NEWPORT BEACH
CA
92660
1
0
0
0
Common Stock
2015-12-31
4
A
0
15812
0.00
A
24608
D
Represents a grant of restricted stock units (RSUs) awarded on December 31, 2015 and scheduled to vest on the first anniversary of the grant date.
Includes unvested RSUs.
/s/ Christina Gong, as attorney-in-fact for Scott A. Bartos
2016-01-15
EX-24.4_626232
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and appoints
each of Richard Johns, Christina Gong and Christianna Rosow, signing singly, the
undersigned's true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in the undersigned's capacity
as an officer and/or director of Alliance HealthCare Services, Inc. (the
"Company"), Forms 3, 4, and 5 in accordance with Section 16(a) of the Securities
Exchange Act of 1934, as amended, and the rules thereunder;
(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 Form 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 his or
her 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 such attorney-in-fact, or 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, nor is the
Company assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934, as amended.
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 12th day of January, 2016.
By:/s/ Scott A. Bartos
Scott A. Bartos