0001610616-16-000005.txt : 20160623
0001610616-16-000005.hdr.sgml : 20160623
20160623145818
ACCESSION NUMBER: 0001610616-16-000005
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160621
FILED AS OF DATE: 20160623
DATE AS OF CHANGE: 20160623
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: 161728487
MAIL ADDRESS:
STREET 1: 80 CERRITOS AVE
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94127
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2016-06-21
0
0000744825
AMERICAN SHARED HOSPITAL SERVICES
AMS
0001610616
Larson David
80 CERRITOS AVE
SAN FRANCISCO
CA
94127
1
0
0
0
Common Stock
2016-06-21
4
A
0
500
0
A
47374
D
Stock Options (right to buy)
2.25
2016-06-21
4
A
0
2000
0
A
2017-06-20
2023-06-20
Common Stock
2000
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, 2016, or (II) such individual's continuation in Board service through the day immediately preceding the 2017 Annual Shareholder's 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, 2016, or (II) such individual's continuation in Board service through the day immediately preceding the 2017 Annual Shareholders Meeting (the "Vesting Date").
/s/ Chloe Tagawa on behalf of David Larson
2016-06-23