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