0001609580-14-000003.txt : 20141024 0001609580-14-000003.hdr.sgml : 20141024 20141024153052 ACCESSION NUMBER: 0001609580-14-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141022 FILED AS OF DATE: 20141024 DATE AS OF CHANGE: 20141024 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: FOUR EMBARCADERO CENTER STREET 2: SUITE 3700 CITY: SAN FRANCISCO STATE: CA ZIP: 94111-4107 BUSINESS PHONE: 415-788-5300 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 3700 CITY: SAN FRANCISCO STATE: CA ZIP: 94111-4107 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: 141172296 MAIL ADDRESS: STREET 1: C/O ASHS STREET 2: FOUR EMBARCADERO CENTER CITY: SAN FRANCISCO STATE: CA ZIP: 94111-4107 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2014-10-22 0 0000744825 AMERICAN SHARED HOSPITAL SERVICES AMS 0001609580 Stachowiak Raymond C C/O ASHS FOUR EMBARCADERO CENTER SAN FRANCISCO CA 94111-4107 1 0 1 0 Common Stock, No Par Value 2014-10-22 4 P 0 100000 2.2 A 555500 I By RCS Investments Inc. Warrants (right to purchase) 2.2 2014-10-22 4 A 0 100000 0 A 2015-10-22 2017-10-22 Common Stock 100000 100000 I By RCS Investments Inc. 1. Includes 500 shares previously reported as owned directly by the Reporting Person. /s/Alexandra Tagawa on behalf of Raymond C. Stachowiak 2014-10-24