0001609580-15-000001.txt : 20150129 0001609580-15-000001.hdr.sgml : 20150129 20150129153923 ACCESSION NUMBER: 0001609580-15-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141230 FILED AS OF DATE: 20150129 DATE AS OF CHANGE: 20150129 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: 15558779 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 2014-12-30 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 Stock Options (right to purchase 2.82 2014-12-30 4 A 0 7500 0 A 2015-12-29 2021-12-29 Common Stock 7500 7500 D The options vest in equal amounts annually over five years beginning on the first anniversary of the grant date. /s/Alexandra Tagawa on behalf of Raymond C. Stachowiak 2015-01-29