0001610616-17-000001.txt : 20170105
0001610616-17-000001.hdr.sgml : 20170105
20170105130632
ACCESSION NUMBER: 0001610616-17-000001
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170103
FILED AS OF DATE: 20170105
DATE AS OF CHANGE: 20170105
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: Larson David
CENTRAL INDEX KEY: 0001610616
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-08789
FILM NUMBER: 17509796
MAIL ADDRESS:
STREET 1: 80 CERRITOS AVE
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94127
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2017-01-03
0
0000744825
AMERICAN SHARED HOSPITAL SERVICES
AMS
0001610616
Larson David
80 CERRITOS AVE
SAN FRANCISCO
CA
94127
1
0
0
0
Common Stock
2017-01-03
4
A
0
5883
0
A
53257
D
These restricted stock units vest over a series of four (4) successive quarters from issuance but settlement has been deferred until after termination of the reporting person's service.
/s/ Chloe Tagawa on behalf of David Larson
2017-01-05