0001437749-22-014095.txt : 20220602 0001437749-22-014095.hdr.sgml : 20220602 20220602143154 ACCESSION NUMBER: 0001437749-22-014095 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220531 FILED AS OF DATE: 20220602 DATE AS OF CHANGE: 20220602 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: 22990295 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 2022-05-31 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 2022-05-31 4 M 0 2000 2.70 A 416178 D Common Stock, No Par Value 57000 I By RCS Investments Inc. Common Stock, No Par Value 760559 I By Stachowiack Equity Fund LLC Stock Options (right to buy) 2.70 2022-05-31 4 M 0 2000 0 D 2016-06-15 2022-06-15 Common Stock 2000 0 D /s/ Craig K. Tagawa on behalf of Raymond C. Stachowiak. 2022-06-02