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