0001609580-19-000004.txt : 20190802
0001609580-19-000004.hdr.sgml : 20190802
20190802190217
ACCESSION NUMBER: 0001609580-19-000004
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190621
FILED AS OF DATE: 20190802
DATE AS OF CHANGE: 20190802
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: 19997287
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: 2 EMBARCADERO CENTER
STREET 2: SUITE 410
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94111
BUSINESS PHONE: 415-788-5300
MAIL ADDRESS:
STREET 1: 2 EMBARCADERO CENTER
STREET 2: SUITE 410
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94111
4
1
wf-form4_156478691118258.xml
FORM 4
X0306
4
2019-06-21
0
0000744825
AMERICAN SHARED HOSPITAL SERVICES
AMS
0001609580
Stachowiak Raymond C
2 EMBARCADERO CENTER
SUITE 410
SAN FRANCISCO
CA
94111
1
0
1
0
Common Stock, No Par Value
2019-06-21
4
A
0
500
0
A
69717
D
Common Stock, No Par Value
57500
I
By RCS Investments Inc.
Common Stock, No Par Value
760559
I
By Stachowiak Equity Fund LLC
Stock Options (right to buy)
3.03
2019-06-21
4
A
0
2000
0
A
2020-06-20
2026-06-20
Common stock
2000.0
2000
D
This represents an award of 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 full upon the earlier of (I) the reporting person's completion of one year of service measured from June 21, 2019, or (II) such individual's continuation in Board service through the day immediately preceding the 2020 Annual Shareholders Meeting (the "Vesting Date").
Includes 500 shares subject to the reported restricted stock unit award which will vest in full on the Vesting Date.
The reported stock option will vest in full upon the earlier of (I) the reporting person's completion of one year of service measured from June 21, 2019, or (II) such individual's continuation in Board service through the day immediately preceding the 2020 Annual Shareholders Meeting (the "Vesting Date").
/s/ Craig K. Tagawa on behalf of Raymond C. Stachowiak
2019-08-02