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