SEC Form 4 · accession 0001674807-17-000002
AMERICAN SHARED HOSPITAL SERVICES · AMS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Daniel G Kelly Jr.
Director
Period of report
Jun 27, 2017
Accepted (ET)
Jun 29, 2017 · 5:40 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000744825
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, No Par ValueF1,F2 | Jun 27, 2017 | A | 500 | $0.00 | A | 11,791 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Options (right to buy)F3 | $3.90 | Jun 27, 2017 | A | 2,000 | A | Jun 26, 2018 | Jun 26, 2024 | Common Stock | 2,000 | 2,000 | D |
Explanation of responses
- F1This 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 27, 2017, or (II) such individual's continuation in Board service through the day immediately preceding the 2018 Annual Shareholders Meeting (the "Vesting Date").
- F2Includes 500 shares subject to the reported restricted stock unit award which will vest in full on the Vesting Date.
- F3The 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 27, 2017, or (II) such individual's continuation in Board service through the day immediately preceding the 2018 Annual Shareholders Meeting (the "Vesting Date").