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