0001609957-17-000001.txt : 20170106 0001609957-17-000001.hdr.sgml : 20170106 20170106174225 ACCESSION NUMBER: 0001609957-17-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170104 FILED AS OF DATE: 20170106 DATE AS OF CHANGE: 20170106 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tagawa Craig Kenji CENTRAL INDEX KEY: 0001609957 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08789 FILM NUMBER: 17515288 MAIL ADDRESS: STREET 1: 5323 SPRINGRIDGE COURT CITY: FAIRFIELD STATE: CA ZIP: 94534 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2017-01-04 0 0000744825 AMERICAN SHARED HOSPITAL SERVICES AMS 0001609957 Tagawa Craig Kenji TWO EMBARCADERO CENTER, SUITE 410 SAN FRANCISCO CA 94111 0 1 0 0 COO/CFO Common Stock 2017-01-04 4 A 0 58824 0 A 87496 D Represents 58,824 performance shares granted to the Reporting Person on January 4, 2017 that will vest upon the Issuer's achievement of pre-determined sales, earnings and related metrics prior to March 31, 2020. /s/ Chloe Tagawa on behalf of Craig K. Tagawa 2017-01-06