0001437749-22-000190.txt : 20220103 0001437749-22-000190.hdr.sgml : 20220103 20220103165342 ACCESSION NUMBER: 0001437749-22-000190 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220103 FILED AS OF DATE: 20220103 DATE AS OF CHANGE: 20220103 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: 22502770 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: 601 MONTGOMERY STREET STREET 2: SUITE 1112 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-788-5300 MAIL ADDRESS: STREET 1: 601 MONTGOMERY STREET STREET 2: SUITE 1112 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 4 1 rdgdoc.xml FORM 4 X0306 4 2022-01-03 0000744825 AMERICAN SHARED HOSPITAL SERVICES AMS 0001609580 Stachowiak Raymond C 601 MONTGOMERY STREET SAN FRANCISCO CA 94111 1 1 1 CEO Common Stock, No Par Value 2022-01-03 4 A 0 120000 0 A 414178 D Common Stock, No Par Value 57000 I By RCS Investments Inc. Common Stock, No Par Value 760559 I By Stachowiack Equity Fund LLC This represents an award of 120,000 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 Equal Quarterly installments on March 31, 2022, June 30, 2022, September 30, 2022 and December 31, 2022. /s/ Craig K. Tagawa on behalf of Raymond C. Stachowiak. 2022-01-03