0000744825-20-000109.txt : 20201013 0000744825-20-000109.hdr.sgml : 20201013 20201013101749 ACCESSION NUMBER: 0000744825-20-000109 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201004 FILED AS OF DATE: 20201013 DATE AS OF CHANGE: 20201013 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stachowiak Raymond C CENTRAL INDEX KEY: 0001609580 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08789 FILM NUMBER: 201235096 MAIL ADDRESS: STREET 1: C/O ASHS STREET 2: 2 EMBARCADERO CENTER-SUITE 410 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN SHARED HOSPITAL SERVICES CENTRAL INDEX KEY: 0000744825 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 942918118 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2 EMBARCADERO CENTER STREET 2: SUITE 410 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-788-5300 MAIL ADDRESS: STREET 1: 2 EMBARCADERO CENTER STREET 2: SUITE 410 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 4 1 wf-form4_160259865578369.xml FORM 4 X0306 4 2020-10-04 0 0000744825 AMERICAN SHARED HOSPITAL SERVICES AMS 0001609580 Stachowiak Raymond C C/O ASHS TWO EMBARCADERO CENTER, STE 410 SAN FRANCISCO CA 94111-4107 1 1 1 0 Interim President and CEO Common Stock, No Par Value 2020-10-04 4 A 0 10000 0 A 158061 D Common Stock, No Par Value 57000 I By RCS Investments Inc. Common Stock, No Par Value 760559 I By Stachowiak Equity Fund LLC This represents an award of 10,000 Restricted Stock Units. Each unit will entitle the reporting person to one share of the issuer's Common Stock upon vesting. The units will vest in full upon the earlier of (i) November 3, 2020 or (ii) the appointment of the reporting person's successor as Chief Executive Officer. /s/ Craig K. Tagawa on behalf of Raymond C. Stachowiak 2020-10-12