0001610616-15-000001.txt : 20150127 0001610616-15-000001.hdr.sgml : 20150127 20150127165120 ACCESSION NUMBER: 0001610616-15-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141230 FILED AS OF DATE: 20150127 DATE AS OF CHANGE: 20150127 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: Larson David CENTRAL INDEX KEY: 0001610616 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08789 FILM NUMBER: 15552302 MAIL ADDRESS: STREET 1: 80 CERRITOS AVE CITY: SAN FRANCISCO STATE: CA ZIP: 94127 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2014-12-30 0 0000744825 AMERICAN SHARED HOSPITAL SERVICES AMS 0001610616 Larson David 80 CERRITOS AVE SAN FRANCISCO CA 94127 1 0 0 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 18500 D The options vest over five (5) years starting 12/29/2015. /s/Alexandra Tagawa on behalf of David Larson 2015-01-27