0000950103-17-000233.txt : 20170106 0000950103-17-000233.hdr.sgml : 20170106 20170106175531 ACCESSION NUMBER: 0000950103-17-000233 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170104 FILED AS OF DATE: 20170106 DATE AS OF CHANGE: 20170106 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: BATES ERNEST A CENTRAL INDEX KEY: 0000946042 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08789 FILM NUMBER: 17515347 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER 3620 CITY: SAN FRANCISO STATE: CA ZIP: 94111-4155 4 1 dp71778_4-bates.xml FORM 4 X0306 4 2017-01-04 0 0000744825 AMERICAN SHARED HOSPITAL SERVICES AMS 0000946042 BATES ERNEST A TWO EMBARCADERO CENTER, SUITE 410 SAN FRANCISO CA 94111 1 1 1 0 Chairman and CEO Common Stock 2017-01-04 4 A 0 66177 0.00 A 655147 D Represents 66,177 performance shares granted to the Reporting Person on January 4, 2017, which vest upon the Issuer's achievement of pre-determined sales, earnings and related metrics before March 31, 2020. /s/ Chloe Tagawa on behalf of Ernest A. Bates 2017-01-06