Document:

EX-10.3

 Exhibit 10.3 

SEPARATION AGREEMENT 

AND GENERAL RELEASE OF CLAIMS 

RENDA and/or RELEASOR, as used herein, refer to LARREE M. RENDA and her heirs, executors, administrators and assigns. 

SAFEWAY and/or COMPANY, as used herein, refer to SAFEWAY INC., and its successors and assigns, parents, subsidiaries, affiliates, partners,
divisions, directors, officers, managers, agents and employees, and each and all of them. 
 RELEASEES, as used herein, refers to SAFEWAY
INC., ALBERTSON’S LLC, NEW ALBERTSON’S, INC., AB ACQUISITION LLC, ALBERTSON’S HOLDINGS LLC, CERBERUS CAPITAL MANAGEMENT, L.P. and their respective successors and assigns, parents, members, shareholders, subsidiaries, affiliates,
partners, divisions, directors, officers, managers, agents, employees, and each and all of them, and RELEASEE refers to any one of the Releasees. 

WHEREAS Renda and Safeway desire to terminate their employment relationship on mutually agreeable terms, as set forth in this Separation
Agreement (“Agreement”); and 
 WHEREAS Renda desires to compromise, settle and fully release any and all claims which she may
have against Safeway and/or any other Releasee(s) related in any way to her employment with Safeway, any term or condition of that employment, or the termination of or opportunity to continue that employment; 

NOW THEREFORE, Renda and Safeway freely and voluntarily enter into and execute this Agreement in consideration of the following terms and
conditions: 
 A. Continued Employment Period. Subject to and in accordance with the terms of this Agreement, Safeway agrees to
employ Renda in her current capacity of Executive Vice President and Chief Administrative Officer (EVP – CAO), from the date of the Renda’s execution of this Agreement until the date her employment is terminated by Renda or Safeway
(“Severance Date”). Subject to and without waiving the provisions of Paragraph 9 below, Safeway further agrees that it will not terminate Renda’s employment before the Closing Date unless the termination is for Cause, as those terms
are defined in Paragraph E below. The time period identified in this Paragraph A shall be referred to as the Continued Employment Period. During the Continued Employment Period, Safeway shall have the right in its discretion to place Renda on Paid
Leave of Absence, during which she will remain eligible for benefits in accordance with Paragraph C, below, and which shall not affect the consideration provided for under this Agreement. 

B. Compensation. During the Continued Employment Period, Renda’s base salary shall be unchanged from that paid in the EVP –
CAO position as of September 1, 2014. 

  
  

 
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 C. Benefits. During the Continued Employment Period, Renda’s retirement, 401(k),
group health (i.e. medical, dental, orthodontia and vision) life insurance, LTD, vacation, and financial planning and tax services benefits shall remain in effect, on the same terms and conditions on which such coverages are made available to
salaried EVP level Safeway employees as of the date of this Agreement, including Renda’s payment of any premiums, deductibles or co-payments allocable to her as a benefit plan participant, if any. 

D. Bonus. Renda shall be paid her bonus for services rendered in 2014 based upon the percentage amount, if any, determined by the
Safeway Executive Compensation Committee or its successor for the Company as a whole, without any discretionary or individual reduction. 

E. Payments. On the closing date of the pending merger between Safeway and affiliates of Albertsons LLC (the “Closing Date”),
Renda shall be paid the sum of $2,243,755 less any applicable withholdings, provided (a) that Renda has not resigned or been terminated for cause pursuant to the terms of the Safeway Inc. Executive Severance Plan (“Cause”) prior to
the Closing Date; and (b) that the conditions set forth in Paragraph 12 have been satisfied in order to make this Agreement effective. As soon as reasonably practicable following the Severance Date, Renda shall be paid the sum of $2,440,070
less any applicable withholdings, provided (a) that Renda’s termination does not result from either a termination for Cause by Safeway or a resignation without Good Reason by Renda (as the terms “Cause” and “Good
Reason” are defined in the Safeway Inc. Executive Severance Plan), and (b) that Renda has executed at that time the release attached hereto as Exhibit A within 10 days following the Severance Date and the revocation period applicable to
such release has expired; provided further, that any payments due to Renda under the Safeway Inc. Retention Bonus Plan that become due prior to the Severance Date shall be paid when due and offset the amount to be paid on the Severance Date. The
parties expressly intend and agree that the payments provided for in this Paragraph E (i) satisfy in full Safeway’s obligations to Renda under the Safeway Inc. Executive Severance Plan and the Safeway Inc. Retention Bonus Plan;
(ii) extinguish any claim by Renda for further benefits under the referenced Plans; and (iii) provide her with valuable consideration and benefits in addition to which she is already entitled under the referenced Plans or otherwise. 

F. Payment of LTIP. With respect to the vesting and payout of performance shares under the Safeway 2012 Performance Share Plan, Renda
will receive the same treatment as other Safeway participants comparable to her level of participation. For example, if it is determined that Safeway executives will vest in a certain percentage of their granted 2014 tranche of shares, then Renda
will also vest in that same percentage of her granted 2014 tranche of shares. 
 G. Outside Activities. Prior to the Severance Date,
Renda may serve as a member of the board of directors of any public or private company or entity so long as such company or entity is not a competitor of, or a party doing business with or seeking 

  
  

 
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to do business with, Safeway, unless expressly permitted by the Company’s General Counsel; and her activities during the Continued Employment Period will otherwise conform to Safeway’s
Code of Business Conduct. 
 In consideration of the foregoing, Renda agrees as follows: 

1. Resignation. Renda agrees to, and hereby does, resign her position as an officer and employee of Safeway on and effective as of the
Severance Date. 
 2. Standards of Conduct. Renda acknowledges that throughout the Continued Employment Period she will be subject
to, and she agrees that she will act in accordance with, the employment policies, standards of conduct, and duties of loyalty and confidentiality that apply to management level employees of the Company. 

3. Release of Claims. Releasor hereby releases and forever discharges each and every Releasee of and from any and all claims, demands,
actions, causes of action, damages and liabilities (all hereinafter referred to as “claims”), whether or not now known, suspected or claimed, which Releasor ever had, now has, or may hereafter claim to have had against any Releasee(s),
relating in any way to her employment with Safeway, any status, term or condition of such employment, the termination of that employment, or her opportunity for employment following the Severance Date. This release of claims is expressly intended
to, and does, extend to and include, but is not limited to, claims under: Title VII of the Civil Rights Act of 1964, as amended; the Equal Pay Act, as amended; the Fair Labor Standards Act, as amended; the Age Discrimination in Employment Act of
1967, as amended; the Americans With Disabilities Act, as amended; the Employee Retirement Income Security Act, as amended; the Older Workers Benefit Protection Act, as amended; the False Claims Act, as amended; the Worker Adjustment and Retraining
Notification Act, as amended; the Sarbanes-Oxley Act of 2002, as amended; the California Fair Employment and Housing Act, as amended; the California Labor Code; and any other federal, state or local statutes, ordinances or regulations prohibiting
any form or forms of discrimination in employment and/or relating to the payment of wages and benefits. This release also extends to and includes, but is not limited to, any claims by Renda for: breach of any express or implied written or oral
contract; intentional or negligent infliction of emotional distress; impairment or interference with economic activities or opportunities; unlawful interference with employment rights; defamation; wrongful termination; wrongful discharge in
violation of public policy; breach of any express or implied covenant of good faith and fair dealing; and any and all other common law contract and/or tort claims. 

Notwithstanding the release of claims otherwise provided for in this section of the Agreement, it is expressly understood that nothing in the
Agreement will prevent Releasor from pursuing rights that cannot be waived as a matter of law, including but not limited to filing a charge of harassment, discrimination or retaliation with the Equal Employment Opportunity Commission (EEOC), or any
of its state or local deferral 

  
  

 
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agencies, or participating in in any investigation by the EEOC or any of its state or local deferral agencies. Further, it is expressly understood that nothing in this Agreement shall be
construed to be a waiver by Releasor of any benefit that vested in any benefit plan prior to the effective date of this Agreement or vested thereafter, or as a waiver of her right to continue any benefit in accordance with the current terms of a
benefit plan or Releasor’s rights, if any, to indemnification granted under any by-law, agreement or charter document of Safeway, policy of insurance or state or federal law. It is also expressly understood that nothing in this Agreement shall
in any way prohibit Releasor from bringing any complaint, claim or action alleging a breach of this Agreement by any Releasee(s). Releasor further agrees that should any person or entity file or bring, or cause or permit to be filed or brought, any
charge, claim, complaint, civil action, suit or other legal proceeding of any type against any Releasee(s) involving any matter occurring at any time in the past, Releasor will not seek or accept personal relief in connection with such charge,
claim, civil action, suit or other legal proceeding. 
 Safeway on behalf of itself and all individuals or entities that may claim through
it hereby releases and forever discharges Renda and all of her assigns, executors, administrators (“Renda Releasees”) of and from any and all claims, demands, actions, causes of actions, damages and liabilities (all hereinafter referred to
as to “Claims”), whether or not now known, suspected or claimed that Safeway ever had, now has, or may hereafter claim to have had against any Renda Releasees relating in any way to Renda’s employment with Safeway, any status or term
of her employment, the termination of that employment, her duties on behalf of Safeway at any time, or her opportunity for employment following the Severance Date. This release is expressly intended to, and does, extend to and include all claims of
any nature at law or in equity since the beginning of time. However, such Release shall not include any claim which results after the effective date of this Agreement or based on any claimed breach of this Agreement. 

4. No Pending or Future Lawsuits. Releasor agrees and covenants that she has not filed or brought any lawsuits, administrative
complaints or charges, either in Releasor’s name or on behalf of any other person or entity, against any Releasee(s) in any local, state or federal court or with any local, state or federal administrative agency. Releasor further represents
that she will not file or bring, or permit to be filed or brought, any charge, claim, complaint, civil action, suit or legal proceeding seeking personal equitable or monetary relief in connection with any matter occurring at any time in the past
concerning Releasor’s employment relationship with Safeway, up to and including the date of this Release, or involving any continuing effects of any acts or practices which have arisen or occurred on or prior to the date of this Release.
Releasor also acknowledges and agrees that upon the payments to be made under this Agreement she has been paid all wages due and owing to her by reason of her employment with Safeway. 

5. Covenant Not to Sue. Renda covenants and agrees never, individually or with any other person or in any way, voluntarily to commence,
aid in any way, prosecute or cause or permit to be commenced or prosecuted against Releasees, or any of them, any action or other proceeding based upon any claim which is released by this Agreement. 

  
  

 
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 6. Sole Right to Claims. Renda represents and warrants that no other person had or has any
interest in the claims referred to in this Agreement; that she has the sole right and exclusive authority to execute this Agreement; and that she has not sold, assigned, transferred, conveyed or otherwise disposed of any claim or demand relating to
any matter covered by this Agreement. 
 7. No Admission of Liability. Renda acknowledges and understands that the consideration
referred to herein is provided without admission or concession by Releasees, or any of them, of any violation of any law or liability to Renda; that said consideration satisfies and fully extinguishes any obligations owed to her by any Releasee(s)
under any prior contract or agreement, and that said consideration provides her with valuable benefits in addition to any to which she already is entitled under Safeway’s employee benefit plans or otherwise. 

8. Release of Unknown Claims. Renda and Safeway expressly waive any right or benefit available in any capacity under the provisions of
Section 1542 of the California Civil Code, which section provides: 
 “A general release does not extend to claims which the
creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.” 

Notwithstanding the provisions of Section 1542, and for the purpose of implementing a full and complete release and
discharge of the Releasees and Renda Releasees, Releasor and Safeway expressly acknowledge that this Agreement is intended to include and does include in its effect, without limitation, all claims which Releasor and Safeway does not know or suspect
to exist in her/its favor against any Releasee(s) and Renda Releasee(s), and that this Agreement expressly contemplates the extinguishment of all such claims. 

Notwithstanding the release of claims otherwise provided for in this section of the Agreement, it is expressly understood that nothing in this
Agreement will prevent Releasor from filing a charge of discrimination with the Equal Employment Opportunity Commission or any of its state or local deferral agencies, or participating in any investigation by the Equal Employment Opportunity
Commission or any of its state or local deferral agencies. Releasor further agrees and covenants, however, that should any agency, commission, person, organization, or other entity file or bring, or cause or permit to be filed or brought, any
charge, claim, complaint, civil action, suit or other legal proceeding involving any matter occurring at any time in the past, Releasor will not seek or accept any personal relief in connection with such proceeding. Further, it is expressly
understood that nothing in this Agreement shall be construed to be a waiver by Releasor of any benefit that vested in any benefit plan prior or after to the effective date of this Agreement, or as a waiver of her right to continue any benefit in
accordance with the terms of a benefit plan. Likewise, nothing in this Agreement shall be construed to waive any right that is not subject to waiver by private agreement, including any right that Releasor may have under California Labor Code
Section 2802 to indemnification of 

  
  

 
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Releasor’s expenses or losses incurred in discharging her duties. However, Releasor acknowledges that she has received reimbursement for all expenses incurred up to the date of his execution
of this Agreement. It is also expressly understood that nothing in this Agreement shall in any way prohibit Releasor from bringing any complaint, claim or action seeking to challenge the validity of this Agreement and/or bringing any complaint claim
or action alleging a breach of this Agreement by the Company or request for indemnification. 
 9. Amendment and Termination. This
Agreement may not be altered, amended or modified, except by a further written document signed by both Renda and Safeway. Notwithstanding anything contained herein to the contrary, in the event the Merger Agreement (as defined in the Safeway Inc.
Retention Bonus Plan) is terminated pursuant to its terms, this Agreement shall automatically terminate and become null and void ab initio. 

10. No Other Consideration. Renda acknowledges and agrees that no consideration other than as provided for in this Agreement has been
or will be paid or furnished by any Releasee; that she will make no claim and hereby waives any right she may now have or may hereafter have, based upon any alleged oral alteration, amendment, modification or any other alleged change in this
Agreement made prior to the Effective Date of the Agreement; and that she understands and has freely and voluntarily entered into and executed this Agreement. 

11. Agreement Is Confidential. Releasor covenants and agrees as of the signing of this Agreement that, except insofar as the terms of
this Agreement are publicly disclosed, she will maintain in confidence the discussions, negotiations and other information relating to this Release and that, unless required to do so by subpoena or other lawful process, and then only to the extent
so required, she will not disclose any such information concerning the Release to any person or entity other than her attorneys, immediate family members and tax advisors. 

12. Renda’s Rights. Renda understands and agrees that: 
  

	 	a.	she has a period of forty-five (45) days to consider this Agreement and determine whether she wishes to execute the same; 

  

	 	b.	any rights or claims that may arise after the date of this Agreement are not waived by her execution of the Agreement; 

  

	 	c.	she is advised carefully to consider the terms of this Agreement and to consult with an attorney of her choice before signing this Agreement; 

 

	 	d.	she has a period of seven (7) days after her execution of the Agreement within which she may revoke the Agreement and that the Agreement shall not become effective or enforceable until the seven-day revocation
period has expired; and 

  
  

 
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	 	e.	in the event that Renda fails timely to execute this Agreement and return the executed original thereof to Safeway, or if Renda timely exercises the right of revocation provided for in Paragraph 11(d), above, then
Releasees shall be relieved of any and all obligations to Renda under this Agreement, but all other obligations shall remain without change. 

13. Confidential Information. Releasor covenants and agrees that, without the express written consent of an executive officer of the
Company, she will not at any time reveal any confidential, proprietary information about Safeway, obtained during the course of her employment with Safeway. This means that Releasor agrees that she shall not disclose to any person or entity at any
time or in any manner, directly or indirectly, any information relating to the operations of Safeway which has not been already disclosed to the general public. Releasor also agrees not to disclose any of the Company’s Confidential Information
including, but not limited to, the following: all information about employees or former employees; proprietary information and/or trade secrets; any information regarding the Company’s operations and pharmacy operations, including without
limitation, information related to its methods, services, pricing, costs, margins, finances, practices, strategies, business plans, agreements, decision-making, systems, technology, policies, procedures, marketing, sales, techniques and processes;
and any other proprietary and/or confidential information relating to the Company’s customers, employees, products, services, sales, technologies, or business affairs (collectively, “Confidential Information”). Releasor agrees that
she will not remove any documents, records, or other information from Company premises containing any such Confidential Information and Releasor acknowledges that such documents, records or other information are the exclusive property of the
Company. 
 14. Cooperation in Lawsuits. Renda covenants and agrees that she will cooperate fully when and as reasonably required by
Safeway in the defense or prosecution of any claims, charges, complaints or lawsuits that have been or may hereafter be filed by or against Safeway. If such cooperation is required following Renda’s resignation of employment, Safeway will
indemnify Renda in the same manner and to the same extent as if she were still employed by Safeway. Such cooperation will include, but is not limited to, meeting with Safeway’s counsel and being available for deposition and/or trial testimony
upon reasonable notice. Safeway agrees to reimburse Renda for reasonable expenses incurred by her in furnishing such cooperation. 
 15.
Non-Disparagement. Releasor covenants and agrees that during the Continued Employment Period and, and for a period of two years thereafter, she will not, whether acting for herself or for any third party, disparage the image or reputation of
any Releasee(s). 

  
  

 
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 16. Injunctive Relief. Renda understands and agrees that a breach of any of the covenants
set forth in paragraphs 4, 5, 8, 10[?], 12, 13 and 14, above, shall be a material breach of the Agreement, for which Safeway may, at its sole option: i) immediately cease providing to Renda any of the benefits provided for in this Agreement; and/or
ii) seek injunctive relief, damages, attorneys’ fees and costs. 
 17. Governing Law. The construction, interpretation, and
enforcement of this Agreement shall be governed by the internal laws of the State of California applicable to contracts made and to be performed wholly within such state, without regard to the conflict of laws rules of any jurisdiction. 

18. Attorneys’ Fees and Expenses. If an action is brought by either party for breach of any provision of this Agreement, the
prevailing party shall be entitled to recover all reasonable attorneys’ and experts’ fees and costs in defending or bringing such action. 

19. Severability. In case any provision of this Release shall be determined to be invalid, illegal or unenforceable for any reason, the
remaining provisions of this Release shall be unaffected and unimpaired thereby and shall remain in full force and effect to the fullest extent permitted by law. 

20. Counterparts. This Agreement may be signed in counterpart originals with the same force and effect as though a single original were
executed. 
 21. Entire Agreement. This Agreement constitutes the entire agreement of the parties hereto with respect to the subject
matter of the Agreement, and the Agreement supersedes all prior agreements between the parties with respect to the subject matter covered herein, whether written or oral, except as otherwise expressly provided herein. In the event this Agreement is
in conflict with or divergent from any other agreement between Renda and Safeway, the terms of this Agreement shall prevail. 
 22.
Internal Revenue Code Section 409A. It is intended that this Agreement comply with, and/or be exempt from, Section 409A of the Internal Revenue Code and the final regulations and official guidance thereunder (“Section
409A”), and any ambiguities herein will be interpreted to so comply with and/or be exempt from Section 409A. Any right to a series of payments pursuant to this Agreement is to be treated as a right to a series of separate payments. This
Agreement shall be administered and interpreted to maximize the short term deferral exemption to Section 409A. The portion of any payment under this Agreement that is paid within the short term deferral exemption (within the meaning of
Section 409A) shall be treated as short term deferral and not aggregated with other payments. In addition, any payments under this Agreement that are not exempt under the short term deferral exemption are meant to be exempt from
Section 409A as paid under an involuntary separation plan. The Company does not guarantee or warrant the tax consequences of the Agreement, and Releasor shall, in all cases, be liable for any taxes due as a result of this Agreement. 

  
  

 
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	Dated: October 15, 2014	 		 	 /s/ Larree M. Renda

		 		 	Larree M. Renda
			
	Dated: October 22, 2014	 		 	Safeway Inc.
			
		 		 	 /s/ Robert A. Gordon

				
		 		 	By:	 	 Robert A. Gordon

				
		 		 	Its:	 	 Senior Vice President

  
  

 
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 EXHIBIT A 

GENERAL RELEASE OF CLAIMS 

AND COVENANT NOT TO SUE 

RENDA and/or RELEASOR, as used herein, refer to LARREE M. RENDA and her heirs, executors, administrators and assigns. 

SAFEWAY and/or COMPANY, as used herein, refer to SAFEWAY INC., and its successors and assigns, parents, subsidiaries, affiliates, partners,
divisions, directors, officers, managers, agents and employees, and each and all of them. 
 RELEASEES, as used herein, refers to SAFEWAY
INC., ALBERTSON’S LLC, NEW ALBERTSON’S, INC., AB ACQUISITION LLC, ALBERTSON’S HOLDINGS LLC, CERBERUS CAPITAL MANAGEMENT, L.P. and their respective successors and assigns, parents, members, shareholders, subsidiaries, affiliates,
partners, divisions, directors, officers, managers, agents, employees, and each and all of them, and RELEASEE refers to any one of the Releasees. 

WHEREAS Renda desires to compromise, settle and fully release any and all claims which she may have against Safeway and/or any other
Releasee(s) related in any way to her employment with Safeway, any term or condition of that employment, the termination of or opportunity to continue that employment, or her eligibility for benefits under the Safeway Inc. Executive Severance Plan
and the Safeway Inc. Retention Bonus Plan (hereinafter, “the Plans”); 
 NOW THEREFORE, Renda freely and voluntarily enters into
and executes this General Release of Claims and Covenant Not to Sue (“Release” or “Agreement”) in consideration of the following terms and conditions: 

A. Severance Date Payment. At the time and subject to the conditions provided for in Paragraph E of the Separation Agreement and
General Release of Claims entered into by and between Renda and Safeway on or about October 22, 2014, and upon condition that Renda does not timely exercise the right of revocation provided for in Paragraph 8(d), below, Safeway will make a lump
sum severance payment to Renda in the amount of $2,440,070, less applicable tax withholdings and less any Retention Bonus payments previously received. Releasor understands and agrees that the payment provided for in this Paragraph satisfies in full
Safeway’s obligations to Releasor under the Plans and extinguishes any claim by Releasor for further benefits under the Plans. 

  
  

 
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 In consideration of the foregoing, Renda agrees as follows: 

1. Release of Claims. Releasor hereby releases and forever discharges each and every Releasee of and from any and all claims, demands,
actions, causes of action, damages and liabilities (all hereinafter referred to as “claims”), whether or not now known, suspected or claimed, which Releasor ever had, now has, or may hereafter claim to have had against any Releasee(s),
relating in any way to her employment with Safeway, any status, term or condition of such employment, the termination of that employment, or her opportunity for employment following the Closing Date. This release of claims is expressly intended to,
and does, extend to and include, but is not limited to, claims under: Title VII of the Civil Rights Act of 1964, as amended; the Equal Pay Act, as amended; the Fair Labor Standards Act, as amended; the Age Discrimination in Employment Act of 1967,
as amended; the Americans With Disabilities Act, as amended; the Employee Retirement Income Security Act, as amended; the Older Workers Benefit Protection Act, as amended; the False Claims Act, as amended; the Worker Adjustment and Retraining
Notification Act, as amended; the Sarbanes-Oxley Act of 2002, as amended; the California Fair Employment and Housing Act, as amended; the California Labor Code; and any other federal, state or local statutes, ordinances or regulations prohibiting
any form or forms of discrimination in employment and/or relating to the payment of wages and benefits. This release also extends to and includes, but is not limited to, any claims by Renda for: breach of any express or implied written or oral
contract; intentional or negligent infliction of emotional distress; impairment or interference with economic activities or opportunities; unlawful interference with employment rights; defamation; wrongful termination; wrongful discharge in
violation of public policy; breach of any express or implied covenant of good faith and fair dealing; and any and all other common law contract and/or tort claims. 

Notwithstanding the release of claims otherwise provided for in this section of the Agreement, it is expressly understood that nothing in the
Agreement will prevent Releasor from pursuing rights that cannot be waived as a matter of law, including but not limited to filing a charge of harassment, discrimination or retaliation with the Equal Employment Opportunity Commission (EEOC), or any
of its state or local deferral agencies, or participating in in any investigation by the EEOC or any of its state or local deferral agencies. Further, it is expressly understood that nothing in this Agreement shall be construed to be a waiver by
Releasor of any benefit that vested in any benefit plan prior to the effective date of this Agreement or vested thereafter, or as a waiver of her right to continue any benefit in accordance with the current terms of a benefit plan or Releasor’s
rights, if any, to indemnification granted under any by-law, agreement or charter document of Safeway, policy of insurance or state or federal law. It is also expressly understood that nothing in this Agreement shall in any way prohibit Releasor
from bringing any complaint, claim or action alleging a breach of this Agreement by any Releasee(s). Releasor further agrees that should any person or entity file or bring, or cause or permit to be filed or brought, any charge, claim, complaint,
civil action, suit or other legal proceeding of any type against any Releasee(s) involving any matter occurring at any time in the past, Releasor will not seek or accept personal relief in connection with such charge, claim, civil action, suit or
other legal proceeding. 

  
  

 
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 2. No Pending or Future Lawsuits. Releasor agrees and covenants that she has not filed or
brought any lawsuits, administrative complaints or charges, either in Releasor’s name or on behalf of any other person or entity, against any Releasee(s) in any local, state or federal court or with any local, state or federal administrative
agency. Releasor further represents that she will not file or bring, or permit to be filed or brought, any charge, claim, complaint, civil action, suit or legal proceeding seeking personal equitable or monetary relief in connection with any matter
occurring at any time in the past concerning Releasor’s employment relationship with Safeway, up to and including the date of this Release, or involving any continuing effects of any acts or practices which have arisen or occurred on or prior
to the date of this Release. Releasor also acknowledges and agrees that upon the payments to be made under this Agreement she has been paid all wages due and owing to her by reason of her employment with Safeway. 

3. Covenant Not to Sue. Renda covenants and agrees never, individually or with any other person or in any way, voluntarily to commence,
aid in any way, prosecute or cause or permit to be commenced or prosecuted against Releasees, or any of them, any action or other proceeding based upon any claim which is released by this Agreement. 

4. Sole Right to Claims. Renda represents and warrants that no other person had or has any interest in the claims referred to in this
Agreement; that she has the sole right and exclusive authority to execute this Agreement; and that she has not sold, assigned, transferred, conveyed or otherwise disposed of any claim or demand relating to any matter covered by this Agreement. 

5. No Admission of Liability. Renda acknowledges and understands that the consideration referred to herein is provided without
admission or concession by Releasees, or any of them, of any violation of any law or liability to Renda; that said consideration satisfies and fully extinguishes any obligations owed to her by any Releasee(s) under any prior contract or agreement,
and that said consideration provides her with valuable benefits in addition to any to which she already is entitled under Safeway’s employee benefit plans, including but not limited to, the Safeway Inc. Executive Severance Plan, or otherwise.

 6. Release of Unknown Claims. Renda expressly waives any right or benefit available in any capacity under the provisions of
Section 1542 of the California Civil Code, which section provides: 
 “A general release does not extend to claims which the
creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.” 

Notwithstanding the provisions of Section 1542, and for the purpose of implementing a full and complete release and
discharge of the Releasees, Releasor expressly acknowledges that this Agreement is intended to include and does include in its effect, without limitation, all 

  
  

 
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claims which Releasor does not know or suspect to exist in her favor against any Releasee(s), and that this Agreement expressly contemplates the extinguishment of all such claims. 

Notwithstanding the release of claims otherwise provided for in this section of the Agreement, it is expressly understood that nothing in this
Agreement will prevent Releasor from filing a charge of discrimination with the Equal Employment Opportunity Commission or any of its state or local deferral agencies, or participating in any investigation by the Equal Employment Opportunity
Commission or any of its state or local deferral agencies. Releasor further agrees and covenants, however, that should any agency, commission, person, organization, or other entity file or bring, or cause or permit to be filed or brought, any
charge, claim, complaint, civil action, suit or other legal proceeding involving any matter occurring at any time in the past, Releasor will not seek or accept any personal relief in connection with such proceeding. Further, it is expressly
understood that nothing in this Agreement shall be construed to be a waiver by Releasor of any benefit that vested in any benefit plan prior or after to the effective date of this Agreement, or as a waiver of her right to continue any benefit in
accordance with the terms of a benefit plan. Likewise, nothing in this Agreement shall be construed to waive any right that is not subject to waiver by private agreement, including any right that Releasor may have under California Labor Code
Section 2802 to indemnification of Releasor’s expenses or losses incurred in discharging her duties. However, Releasor acknowledges that she has received reimbursement for all expenses incurred up to the date of his execution of this
Agreement. It is also expressly understood that nothing in this Agreement shall in any way prohibit Releasor from bringing any complaint, claim or action seeking to challenge the validity of this Agreement and/or bringing any complaint claim or
action alleging a breach of this Agreement by the Company or request for indemnification. 
 7. No Other Consideration. Renda
acknowledges and agrees that no consideration other than as provided for in this Agreement has been or will be paid or furnished by any Releasee; that she will make no claim and hereby waives any right she may now have or may hereafter have, based
upon any alleged oral alteration, amendment, modification or any other alleged change in this Agreement made prior to the Effective Date of the Agreement; and that she understands and has freely and voluntarily entered into and executed this
Agreement. 
 8. Renda’s Rights. Renda understands and agrees that: 

 

	 	a.	she has a period of forty-five (45) days to consider this Agreement and determine whether she wishes to execute the same; 

  

	 	b.	any rights or claims that may arise after the date of this Agreement are not waived by her execution of the Agreement; 

  
  

 
 Page 13 

	 	c.	she is advised carefully to consider the terms of this Agreement and to consult with an attorney of her choice before signing this Agreement; 

 

	 	d.	she has a period of seven (7) days after her execution of the Agreement within which she may revoke the Agreement and that the Agreement shall not become effective or enforceable until the seven-day revocation
period has expired; and 

  

	 	e.	in the event that Renda fails timely to execute this Agreement and return the executed original thereof to Safeway, or if Renda timely exercises the right of revocation provided for in Paragraph 8(d), above, then
Releasees shall be relieved of any and all obligations to Renda under this Agreement, but all other obligations shall remain without change. 

9. Governing Law. The construction, interpretation, and enforcement of this Agreement shall be governed by the internal laws of the
State of California applicable to contracts made and to be performed wholly within such state, without regard to the conflict of laws rules of any jurisdiction. 

10. Attorneys’ Fees and Expenses. If an action is brought by either party for breach of any provision of this Agreement, the
prevailing party shall be entitled to recover all reasonable attorneys’ and experts’ fees and costs in defending or bringing such action. 

11. Severability. In case any provision of this Agreement shall be determined to be invalid, illegal or unenforceable for any reason,
the remaining provisions of the Release and this Agreement shall be unaffected and unimpaired thereby and shall remain in full force and effect to the fullest extent permitted by law. 

12. Counterparts. This Agreement may be signed in counterpart originals with the same force and effect as though a single original were
executed. 
 13. Entire Agreement. This Agreement constitutes the entire agreement of the parties hereto with respect to the subject
matter of the Agreement, and the Agreement supersedes all prior agreements between the parties with respect to the subject matter covered herein, whether written or oral, except as otherwise expressly provided herein. 

14. Internal Revenue Code Section 409A. It is intended that this Agreement comply with, and/or be exempt from, Section 409A
of the Internal Revenue Code and the final regulations and official guidance thereunder (“Section 409A”), and any ambiguities herein will be interpreted to so comply with and/or be exempt from Section 409A. Any right to a series of
payments pursuant to this Agreement is to be treated as a right to a series of separate payments. This Agreement shall be administered and interpreted to 

  
  

 
 Page 14 

 
maximize the short term deferral exemption to Section 409A. The portion of any payment under this Agreement that is paid within the short term deferral exemption (within the meaning of
Section 409A) shall be treated as short term deferral and not aggregated with other payments. In addition, any payments under this Agreement that are not exempt under the short term deferral exemption are meant to be exempt from
Section 409A as paid under an involuntary separation plan. The Company does not guarantee or warrant the tax consequences of the Agreement, and Releasor shall, in all cases, be liable for any taxes due as a result of this Agreement. 

 

							
	Dated: ____________________, 2014	 		 	  

		 		 	Larree M. Renda
			
	Dated: ____________________,2014	 		 	Safeway Inc.
			
		 		 	  

				
		 		 	By:	 	  

				
		 		 	Its:	 	  

  
  

 
 Page 15Exhibit 10.1

 

AMERICAN SHARED HOSPITAL SERVICES

 

NOTE AND WARRANT PURCHASE AGREEMENT

 

This Note and Warrant Purchase Agreement,
dated as of October 22, 2014, (this “Agreement”) is entered into between and among American Hospital Services,
a California corporation (the “Company”), and the investors listed on Schedule I hereto (each an “Investor”
and, collectively, the “Investors”). Capitalized terms not otherwise defined herein shall have the meaning set
forth in the form of Note (as defined below) or Warrant (as defined below) attached hereto as Exhibits A and B, respectively.

 

RECITALS

 

WHEREAS, the Company has requested that
the Investors invest the aggregate sum of $1,000,000 in return for (i) promissory notes in the principal amount set forth opposite
such Investor’s name on Schedule I hereto and (ii) certain warrants to purchase shares of the Company’s class of Common
Stock No Par Value (the “Common Stock”), and the Investors are willing to make such investment in the Company
on the terms and conditions set forth herein (the “Notes and Warrants Purchase”);

 

WHEREAS, the Investors are members of the
board of directors of the Company;

 

WHEREAS, the Company and Investors are executing
and delivering this Agreement upon the exemption from securities registration afforded by the rules and regulations as promulgated
by the Securities and Exchange Commission (the “SEC”) under Section 4(a)(2) of the Securities Act of 1933, as
amended (the “Securities Act”).

 

AGREEMENT

 

NOW THEREFORE, in consideration of the foregoing
and the provisions set forth below, the parties hereby agree as follows:

 

1. Purchase and Sale. At
the Closing (as defined below), on the terms and subject to the conditions set forth herein, each Investor will severally purchase
from the Company, and the Company will issue and sell severally to each Investor, (i) a promissory note in the form of Exhibit
A hereto (each a “Note” and collectively the “Notes”) in the principal amount set forth opposite
the Investor’s name on Schedule I hereto and (ii) a warrant in the form of Exhibit B hereto (each a “Warrant”
and collectively the “Warrants,” and collectively with the Notes and this Agreement, the “Transaction
Documents”) in accordance with the Investor’s individual allocation as set forth on Schedule I hereto.

 

    	 

    	 

    

 

2. Closing and Delivery of the Notes,
Warrants and Funds

 

(a)Closing. The closing of the
sale of the Notes and Warrants (the “Closing”) shall occur remotely via exchange of documents and signatures
on October 22, 2014 (the “Closing Date”).

 

(b)Delivery. At the Closing, the
Company will deliver to each of the Investors the Note and Warrants to be purchased by such Investor, against receipt by the Company
of the purchase price set forth on Schedule I hereto (the “Purchase Price”).

 

3. Warrants.

 

(a)Issuance. At
the Closing, the Company shall issue the Warrants to the Investors as provided in Section 1. Each Warrant shall be exercisable
at an exercise price of $2.20 per share (the “Exercise Price”), which is the closing price per share of the
Common Stock on the New York Stock Exchange MKT on the day preceding the date hereof, and shall expire on the third anniversary
of the Closing Date.

 

(b)Waiver of Standstill.
The Company hereby waives any rights it may have pursuant to provision 3(e) (the “Standstill”) of that certain
Common Stock Purchase Agreement, dated as of June 11, 2014, between and among the Company and certain of the Investors (the “Common
Stock Purchase Agreement”), to prevent Investors from purchasing and exercising the Warrants. It is understood that the
Standstill otherwise remains in full force and effect.

 

(c)Registration Rights. The
Warrant will contain the same registration rights with respect to the Common Stock underlying the Warrant (the “Warrant
Shares”) as were granted to investors in the Common Stock Purchase Agreement, except that with respect to the Warrant
Shares, the Company agrees to keep the Registration Statement and Prospectus (each as defined in the Common Stock Purchase Agreement)
effective and current, respectively, for three years from the date the Registration Statement was filed, or if earlier, until such
time as the number of Warrant Shares remaining unsold may be sold by Investors within 12 months in open market transactions under
Rule 144.

 

4. Representations, Warranties and
Covenants of the Company. The Company represents and warrants to each Investor that, as of the date hereof:

 

(a)Due Incorporation, Qualification,
etc. The Company is duly formed and validly existing under the laws of California, with full power and authority to conduct
its business as it is currently being conducted and to own its assets, and has secured any other authorizations, approvals, permits
and orders required by law for the conduct by the Company of its business as it is currently being conducted.

 

    	2

    	 

    

 

(b)Authority. The execution,
delivery and performance by the Company of each Transaction Document to be executed by the Company and the consummation of the
transactions contemplated thereby are within the power of the Company and have been duly authorized by all necessary actions on
the part of the Company.

 

(c)Amendment of Rights Plan.
The Company agrees to amend promptly its existing shareholder rights plan, dated as of March 22, 1999, between the Company and
American Stock Transfer & Trust Company, as rights agent, as amended by the first amendment dated as of March 12, 2009 (the
“Rights Plan”) so that the issuance and subsequent exercise of the Warrants does not activate any rights issued
to the Company’s shareholders pursuant to the Rights Plan.

 

(d)No Approvals. No consent
or authorization of, filing with, notice to or other act by, or in respect of, any governmental authority or any other person is
required in order for the Company to execute, deliver, or perform any of its obligations under the Notes or Warrants.

 

(e)No Violations. The execution
and delivery of the Notes and Warrants and the consummation by the Company of the transactions contemplated hereby and thereby
do not and will not (a) violate any provision of the Company's organizational documents; (b) violate any law or order applicable
to the Company or by which any of its properties or assets may be bound; or (c) constitute a default under any material agreement
or contract by which the Company may be bound.

 

(f)Enforceability. Each of
the Note and Warrant is a valid, legal and binding obligation of the Company, enforceable against it in accordance with their terms
except as enforceability may be limited by applicable bankruptcy, insolvency, reorganization, moratorium or similar laws affecting
the enforcement of creditors' rights generally and by general equitable principles (whether enforcement is sought by proceedings
in equity or at law).

 

(g)Reservation of Shares.
The Company shall at all times reserve and keep available out of its authorized but unissued Common Stock, solely for the purpose
of issuance upon the exercise of the Warrant, the maximum number of Warrant Shares issuable upon the exercise thereof. The Company
shall take all such actions as may be necessary or appropriate in order that the Company may validly and legally issue fully paid
and nonassessable shares of Common Stock upon the exercise of the Warrant.

 

5. Representations, Warranties and
Covenants of Investors. Each Investor, for that Investor alone, represents and warrants to the Company as follows:

 

    	3

    	 

    

 

(a)Authority. Each Investor has
full legal capacity, power and authority to execute and deliver this Agreement and to perform its obligations hereunder.

 

(b)Securities Law Compliance. Each
Investor acknowledges that the Notes and the Warrants have not been registered under the Securities Act, or any state securities
laws and, therefore, cannot be resold unless they are registered under the Securities Act and applicable state securities laws
or unless an exemption from such registration requirements is available. Such Investor is aware that the Company is under no obligation
to effect any such registration with respect to the Notes or Warrants or to file for or comply with any exemption from registration.
Such Investor has not been formed solely for the purpose of making this investment and is purchasing the Notes and Warrants to
be acquired by such Investor hereunder for its own account for investment, not as a nominee or agent, and not with a view to, or
for resale in connection with, the distribution thereof.

 

(c)Accredited Investor. Each Investor
is an accredited investor as such term is defined in Rule 501 of Regulation D under the Securities Act.

 

(d)Filings. Each Investor agrees
to either file or amend an existing Statement of Beneficial Ownership on Schedule 13D or 13G, whichever is applicable, with the
SEC within five days of the Closing Date.

 

6. Miscellaneous

 

(a)Changes. This Agreement may
only be amended, modified or supplemented by an agreement in writing signed by each party hereto.

 

(b)Governing Law. This Agreement
and all actions arising out of this Agreement shall be governed by and construed in accordance with the laws of the State of California,
without regard to the conflicts of law provisions of the State of California or of any other state.

 

(c)Survival. The representations,
warranties, covenants and agreements made herein shall survive the execution and delivery of this Agreement.

 

(d)Successors and Assigns. Subject
to the restrictions on transfer described in Section ‎6(e) below, the rights and obligations of the Company and the Investors
shall be binding upon and benefit the successors, assigns, heirs, administrators and transferees of the parties.

 

(e)Assignment by the Company. The
rights, interests or obligations hereunder may not be assigned, by operation of law or otherwise, in whole or in part, by the Company
without the prior written consent of Investors.

 

(f)Entire Agreement. This Agreement
together with the other Transaction Documents constitute the entire agreement among the Company and Investors and supersede any
and all prior agreements, negotiations, understandings and communications among the parties, whether written or oral, respecting
the subject matter hereof.

 

    	4

    	 

    

 

(g)Notices. All notices and other
communications shall be made in writing and shall be deemed effectively given upon the earlier of actual receipt or: (i) personal
delivery to the party to be notified; (ii) when sent, if sent by electronic mail or facsimile; (iii) five days after having been
sent by registered or certified mail; or (iv) one business day after the business day of deposit with a nationally recognized overnight
courier. All communications shall be sent to the following addresses:

 

	If to the Company, to: 	American Shared Hospital Services
	 	Four Embarcadero Center, Suite 3700
	 	San Francisco, CA 94111
	 	Facsimile: (415) 788-5660
	 	Attention: Craig K. Tagawa, Chief Operating Officer and 

Chief Financial Officer
	 	 
	With copies to:	Davis Polk & Wardwell LLP
	 	1600 El Camino Real
	 	Menlo Park, CA 94025
	 	Facsimile: (650) 752-3601
	 	Attention: Daniel G. Kelly, Jr.

 

If to Investors, to its address on the Company’s records
or to such other mailing address or email address as the Company or Investors may designate in writing.

 

(h)Severability of this Agreement.
If any provision of this Agreement shall be judicially determined to be invalid, illegal or unenforceable, the validity, legality
and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

 

(i)Expenses. The Company shall
reimburse the Investors up to $ to cover their legal and other expenses incurred in connection with the Transaction Documents and
the transactions contemplated thereby.

 

    	5

    	 

    

 

(j)Conflict Waiver. Investors hereby
consent to the continued representation of the Company and its board of directors by Davis Polk & Wardwell LLP (“Davis
Polk”) in relation to the Notes and Warrants Purchase and voluntarily and knowingly waive any actual or alleged conflict
and actual or alleged violation of ethical or comparable rules applicable to Davis Polk that may arise from its representation
of the Company and its board of directors in connection with the Notes and Warrants Purchase. In addition, the Investors hereby
acknowledge that their consent and waiver under this Section 6(j) is voluntary and informed, and that the Investors have been advised
of their rights to obtain independent legal advice with respect to this consent and waiver. The Investors further agree that they
are aware of the extent of their relationship, if any, with Davis Polk, and the Investors do not require additional information
from Davis Polk in order to understand the nature of this consent. Davis Polk is an express third party beneficiary of this Section
6(j).

 

(k)Counterparts. This Agreement
may be executed in one or more counterparts, each of which will be deemed an original, but all of which together will constitute
one agreement.

 

(Signature Page Follows)

 

    	6

    	 

    

 

The parties have caused this Agreement to
be duly executed and delivered as of the date and year first written above.

 

	
        

        COMPANY:

        
 
	 
	 	 
	AMERICAN SHARED HOSPITAL SERVICES	 
	 	 
	By:	/s/ Ernest A. Bates, M.D.	 

 

[Signature Page
to Note and Warrant Purchase Agreement]

 

    	 

    	 

    

 

INVESTORS:

 

	
        

        Raymond C. Stachowiak

	By:	/s/ Raymond C. Stachowiak	 	 

 

	John F. Ruffle
	By:	/s/ John F. Ruffle	 	 

 

	Mert Ozyurek
	By:	/s/ Mert Ozyurek	 	 

 

	David A. Larson, M.D.
	By:	/s/ David A. Larson, M.D.	 	 

 

    	 

    	 

    

 

SCHEDULE I

 

	Name and Address	 	Note Amount	 	 	Warrant Shares	 
	Raymond C. Stachowiak	 	$	500,000	 	 	 	100,000	 
	John F. Ruffle	 	$	250,000	 	 	 	50,000	 
	Mert Ozyurek	 	$	200,000	 	 	 	40,000	 
	David A. Larson, M.D.	 	$	50,000	 	 	 	10,000	 

 

    	 

    	 

    

 

Exhibit A

FORM OF NOTE

 

    	 

    	 

    

 

THIS NOTE HAS NOT BEEN REGISTERED UNDER
THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”) OR UNDER ANY STATE SECURITIES LAW. IT MAY NOT BE SOLD, OFFERED FOR
SALE, PLEDGED OR HYPOTHECATED EXCEPT PURSUANT TO THE PROVISIONS OF THE ACT AND APPLICABLE STATE SECURITIES LAWS OR AN OPINION OF
COUNSEL SATISFACTORY TO THE COMPANY THAT SUCH SALE, ASSIGNMENT, PLEDGE OR TRANSFER IS IN COMPLIANCE WITH AN AVAILABLE EXEMPTION
UNDER THE ACT AND APPLICABLE STATE SECURITIES LAWS.

 

AMERICAN SHARED HOSPITAL SERVICES

PROMISSORY NOTE

 

	$[       ]	October 22, 2014
	 	San Francisco, California

 

FOR VALUE RECEIVED, AMERICAN SHARED HOSPITAL
SERVICES, a California corporation (the “Company”) promises to pay to [      ] (the “Investor”),
or his registered assigns, in lawful money of the United States of America the principal sum of [      ] US dollars ($[      ]), or such
lesser amount as shall equal the outstanding principal amount hereof, together with simple interest from the date of this Note
on the unpaid principal balance at a rate equal to 15% per annum, computed on the basis of a 360-day year of twelve 30-day months.
All unpaid principal, together with any then unpaid and accrued interest and other amounts payable hereunder, shall be due and
payable on October 22, 2017 (the “Maturity Date”). This Note is one of the “Notes” issued pursuant
to the Note and Warrant Purchase Agreement of even date herewith (the “Note and Warrant Purchase Agreement”)
between the Company and the Investors (as defined therein).

 

The following is a statement of the rights
of Investor and the conditions to which this Note is subject, and to which Investor, by the acceptance of this Note, agrees:

 

1.Interest. The Company
promises to pay interest on the principal amount of this Note at the rate per annum described above. Interest on the Note will
accrue from the most recent date to which interest has been paid; or, if no interest has been paid, from October 22, 2014. The
Company will pay interest monthly on the 22nd of each month (each an “Interest Payment Date”), commencing with
the first Interest Payment Date next succeeding the date hereof, and at the Maturity Date; provided that any payment of
interest to be made on any Interest Payment Date or on the Maturity Date that is not a Business Day shall be made on the next succeeding
Business Day with the same force and effect as if made on such Interest Payment Date or the Maturity Date, as the case may be,
and no additional interest shall accrue as a result of such delayed payment. The term “Business Day” means any
day, that is not a Saturday or Sunday, and that is not a day on which banking institutions in New York City are generally authorized,
obligated or by law or executive order to be closed.

 

    	 

    	 

    

 

2.Prepayment.

 

(a)Optional Prepayment. The
Company shall have the right to prepay the outstanding principal amount of the Note and any accrued interest thereon (collectively,
the “Outstanding Balance”) in whole or in part without penalty or premium on any date on or after December 31,
2015.

 

(b)Mandatory Prepayment.
The Company shall, within five (5) days following the consummation of the Fifth Milestone Payment (as defined below), prepay the
Outstanding Balance of this Note in whole without penalty or premium. For purposes of this Section 2(b), the term “Fifth
Milestone Payment” shall mean payment by a third party financial institution to Mevion Medical Systems, Inc. (“Mevion”)
of the fifth milestone payment referenced in that certain System Build Agreement dated as of February 26, 2007 by and between the
Company and Mevion and $2,000,000 to reimburse the Company for the third and fourth milestone payments.

 

(c)Repayment upon Mevion IPO.
In the event of the initial public offering of the common stock of Mevion (the “Mevion IPO”), if this Note has
not previously been fully repaid, then, upon receipt of a written request from an Investor, the Company shall sell some or all
of its shares of Mevion’s common stock (the “Mevion Shares”) and promptly use the proceeds of such sale
to prepay the Outstanding Balance of this Note in whole or in part without penalty or premium, provided that the Company
shall be under no obligation to sell any Mevion Shares until the Company’s lock-up agreement in connection with the Mevion
IPO has expired. Any such prepayment shall be made on a pro rata basis among the Notes issued pursuant to the Note and Warrant
Purchase Agreement based on the principal amount of each Note then outstanding.

 

3.Events of Default

 

(a)Each of the following shall constitute
an “Event of Default”:

 

(i)Failure to Pay.  The Company
fails to pay (a) any principal amount of this Note when due or (b) interest or any other amount when due and such failure continues
for five (5) days after written notice to the Company.

 

(ii)Breach of Representations,
Warranties or Covenants. Any representation or warranty made or deemed made by the Company in the Note and Warrant Purchase
Agreement is incorrect in any material respect on the date as of which such representation or warranty was made or deemed made.
The Company fails to observe or perform (a) any covenant, condition or agreement contained in the Note and Warrant Purchase Agreement
or (b) any other covenant, obligation, condition or agreement contained in this Note and such failure continues for 30 days after
written notice to the Company.

 

    	2

    	 

    

 

(iii)Voluntary Bankruptcy or Insolvency
Proceedings. The Company shall (i) apply for or consent to the appointment of a receiver, trustee, liquidator or custodian
of itself or of all or a substantial part of its property, (ii) be unable, or admit in writing its inability, to pay its debts
generally as they mature, (iii) make a general assignment for the benefit of its or any of its creditors, (iv) be dissolved or
liquidated, (v) become insolvent (as such term may be defined or interpreted under any applicable statute), (vi) commence a voluntary
case or other proceeding seeking liquidation, reorganization or other relief with respect to itself or its debts under any bankruptcy,
insolvency or other similar law now or hereafter in effect or consent to any such relief or to the appointment of or taking possession
of its property by any official in an involuntary case or other proceeding commenced against it, or (vii) take any action for the
purpose of effecting any of the foregoing; or

 

(iv)Involuntary Bankruptcy or Insolvency
Proceedings. Proceedings for the appointment of a receiver, trustee, liquidator or custodian of the Company or of all or a
substantial part of the property thereof, or an involuntary case or other proceedings seeking liquidation, reorganization or other
relief with respect to the Company or the debts thereof under any bankruptcy, insolvency or other similar law now or hereafter
in effect shall be commenced and an order for relief entered or such proceeding shall not be dismissed or discharged within 30
days of commencement.

 

(b)If an Event of Default (other than
an Event of Default specified in clause (iii) or (iv) of Section 3(a) hereof with respect to the Company) shall have occurred and
is continuing, Investors holding at least 50% of the principal amount of the then outstanding Notes may declare the principal of,
and accrued and unpaid interest on the Note to be due and payable by notice in writing to the Company and the same shall become
immediately due and payable.

 

If an Event of Default specified in clause
(iii) or (iv) of Section 3(a) hereof with respect to the Company occurs and is continuing, then the entire outstanding principal
amount of the Note will automatically become due immediately and payable in each and every case without presentment, demand, protest
or further notice, all of which are hereby waived by the Company.

 

4.Successors and Assigns.
Subject to the restrictions on transfer described in Sections 6 and 7 below, the rights and obligations of the Company and the
Investor shall be binding upon and benefit the successors, assigns, heirs, administrators and transferees of the parties.

 

    	3

    	 

    

 

5.Waiver and Amendment.
Any provision of this Note may be amended, waived or modified upon the written consent of the Company and the Investor; provided
that the terms of this Note relating to the payment of the principal amount of and interest on this Note shall not be amended,
waived or modified except by the Investor holding this Note.

 

6.Assignment by the Company.
Neither this Note nor any of the rights, interests or obligations hereunder may be assigned, by operation of law or otherwise,
in whole or in part, by the Company without the prior written consent of the Investor.

 

7.Notices. All notices,
requests, demands, consents, instructions or other communications required or permitted hereunder shall in writing and faxed, mailed
or delivered to each party at the respective addresses of the parties as set forth in the Note and Warrant Purchase Agreement,
or at such other address or facsimile number as the Company shall have furnished to the Investor in writing. All such notices and
communications will be deemed effectively given the earlier of (i) when received, (ii) when delivered personally, (iii) one business
day after being delivered by facsimile (with receipt of appropriate confirmation), (iv) one business day after being deposited
with an overnight courier service of recognized standing or (v) four days after being deposited in the U.S. mail, first class with
postage prepaid.

 

8.Usury. If any interest
is paid on this Note which is deemed to be in excess of the then legal maximum rate, then that portion of the interest payment
representing an amount in excess of the then legal maximum rate shall be deemed a payment of principal and applied against the
principal of this Note.

 

9.Waivers. The Company
hereby waives notice of default, presentment or demand for payment, protest or notice of nonpayment or dishonor and all other notices
or demands relative to this instrument.

 

10.Governing Law. This
Note and all actions arising out of or in connection with this Note shall be governed by and construed in accordance with the laws
of the State of California, without regard to the conflicts of law provisions of the State of California, or of any other state.

 

    	4

    	 

    

 

The Company has caused this Note to be issued
as of the date first written above.

 

	 	AMERICAN SHARED HOSPITAL SERVICES
	 	By:	 

 

    	 

    	 

    

 

Exhibit B

FORM OF WARRANT

 

    	 

    	 

    

 

AMERICAN SHARED HOSPITAL SERVICES

WARRANT FOR THE PURCHASE OF SHARES OF

COMMON STOCK OF AMERICAN SHARED HOSPITAL SERVICES

 

	
        

        No. ____
	Warrant to Purchase

_________ Shares

 

THIS SECURITY HAS NOT BEEN REGISTERED
UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”) OR UNDER ANY STATE SECURITIES LAW. IT MAY NOT BE SOLD, OFFERED
FOR SALE, PLEDGED OR HYPOTHECATED EXCEPT PURSUANT TO THE PROVISIONS OF THE ACT AND APPLICABLE STATE SECURITIES LAWS OR AN OPINION
OF COUNSEL SATISFACTORY TO THE COMPANY THAT SUCH SALE, ASSIGNMENT, PLEDGE OR TRANSFER IS IN COMPLIANCE WITH AN AVAILABLE EXEMPTION
UNDER THE ACT AND APPLICABLE STATE SECURITIES LAWS.

 

FOR VALUE RECEIVED, AMERICAN SHARED HOSPITAL
SERVICES, a California corporation (the “Company”), hereby certifies that [      ], his successor or permitted
assigns (the “Holder”), is entitled, subject to the provisions of this Warrant, to purchase from the Company,
at the times specified herein, [      ] fully paid and non-assessable shares of Common Stock of the Company, no par value per share
(the “Common Stock”), at a purchase price per share equal to the Exercise Price (as hereinafter defined). The
number of shares of Common Stock to be received upon the exercise of this Warrant and the price to be paid for a share of Common
Stock are subject to adjustment from time to time as hereinafter set forth.

 

1. Definitions. a) The following
terms, as used herein, have the following meanings:

 

“Affiliate” means, with
respect to any Person, any other Person directly or indirectly controlling, controlled by or under common control with such Person.
For the purpose of this definition, the term “control” (including, with correlative meanings, the terms “controlling”,
“controlled by” and “under common control with”), as used with respect to any Person, means
the possession, directly or indirectly, of the power to direct or cause the direction of the management and policies of such Person,
whether through the ownership of voting securities, by contract or otherwise.

 

“Aggregate Offering Price”
shall mean, calculated on a per share of Common Stock basis, (i) in respect of any Common Stock, the consideration received by
the Company for the issuance of such Common Stock and (ii) in respect of any convertible securities (as defined in paragraph ‎8(b)),
the sum of (A) the consideration received by the Company for the issuance of such convertible securities plus (B) the consideration
payable to the Company upon exercise, exchange or conversion in full of such convertible securities (excluding the forfeiture of
such convertible securities) for the issuance of the underlying shares of Common Stock.

 

    	2

    	 

    

 

“Board of Directors”
means the board of directors of the Company.

 

“Business Day” means
any day except a Saturday, Sunday or other day on which commercial banks in the City of New York are authorized by law to close.

 

“Current Market Price Per Common
Share” means, on any determination date, the average of the Daily Prices per share of Common Stock for the 20 consecutive
trading days immediately prior to such date. If, on any determination date, the shares of Common Stock are not traded on a national
securities exchange or quoted by any regulated quotation service, the Current Market Price Per Common Share shall be the fair market
value per share as determined in good faith by the Board.

 

“Daily Price” means (i)
if the shares of Common Stock are then listed and traded on a national securities exchange, the closing price on the applicable
day as reported by the principal national securities exchange on which such shares are listed and traded and (ii) if such shares
are not then listed and traded on a national securities exchange, the closing price on such day as quoted by any regulated quotation
service.

 

“Excluded Securities”
means shares of Common Stock issued or issuable (i) pursuant to the Company’s stock option plan or any similar employee compensation
plan of the Company that is approved by the Board of Directors, (ii) pursuant to the exercise of any convertible securities if
no adjustment was required pursuant to paragraph 7(b) at the time such convertible security was issued, (iii) pursuant to an underwritten
public offering and (iv) as consideration for or to fund the acquisition of any company, business or asset.

 

“Exercise Price” means
$2.20 per Warrant Share, as the same may be adjusted from time to time as provided in this Warrant.

 

“Expiration Time” means
5:00 p.m. New York City on the third anniversary of the Closing Date or, if such day is not a Business Day, then until 5:00 p.m.
New York City time on the next succeeding day that is a Business Day.

 

“Note and Warrant Purchase Agreement”
means the Note and Warrant Purchase Agreement dated as of the date hereof among the Company and the holders listed on the signature
pages thereto, as the same may be amended from time to time.

 

    	3

    	 

    

 

“Person” means an individual,
corporation, partnership, limited liability company, association, trust or other entity or organization, including a government
or political subdivision or an agency or instrumentality thereof.

 

“Warrant Shares” means
the shares of Common Stock deliverable upon exercise of this Warrant, as the same may be adjusted from time to time as provided
in this Warrant.

 

(b)Capitalized terms used but
not defined in this Warrant shall have the meanings assigned to such terms in the Note and Warrant Purchase Agreement.

 

2. Exercise of Warrant.

 

(a)The Holder is entitled to
exercise this Warrant in whole or in part at any time, or from time to time, commencing on the first anniversary of the Closing
Date and ending at the Expiration Time. To exercise this Warrant, the Holder shall deliver to the Company i) an executed Warrant
Exercise Notice substantially in the form annexed to this Warrant, ii) this Warrant and iii) subject to paragraph ‎2(e), the
applicable Exercise Price. Upon such delivery and payment, the Holder shall be deemed to be the holder of record of the Warrant
Shares subject to such exercise, notwithstanding that the stock transfer books of the Company shall then be closed or that certificates
representing such Warrant Shares shall not then be actually delivered to the Holder.

 

(b)The Exercise Price may be
paid either by wire transfer of immediately available funds to an account designated by the Company or by certified or official
bank check or bank cashier’s check payable to the order of the Company. The Company shall pay any and all documentary, stamp
or similar issue or transfer taxes payable in respect of the issue or delivery of the Warrant Shares; provided that the
Company shall not be required to pay any taxes that may be payable in respect of any transfer involved in the issuance and delivery
of the Warrant Shares in a name other than that of the Holder.

 

(c)If the Holder exercises this
Warrant in part, this Warrant shall be surrendered by the Holder to the Company and a new Warrant of the same tenor and for the
unexercised number of Warrant Shares registered in the name of the Holder shall be executed by the Company as promptly as reasonably
practicable.

 

(d)Upon surrender of this Warrant
in conformity with the foregoing provisions, the Company shall transfer to the Holder appropriate evidence of ownership of the
shares of Common Stock or other securities or property (including any money) to which the Holder is entitled, registered or otherwise
placed in, or payable to the order of, the name or names of the Holder as may be directed in writing by the Holder, and shall promptly
deliver such evidence of ownership and any other securities or property (including any money) to the Person or Persons entitled
to receive the same, together with an amount in cash in lieu of any fraction of a share as provided in paragraph ‎5 below.

 

    	4

    	 

    

 

(e)In lieu of making a cash payment
of the Exercise Price to exercise this Warrant pursuant to paragraph ‎2(a) (but in all other respects in accordance with the
exercise procedure set forth in paragraph ‎2(a)), the Holder may elect to convert this Warrant into shares of Common Stock,
in which event the Company will issue to the Holder the number of shares of Common Stock equal to the amount resulting from the
following equation:

 

X = (A - B) x C where:

A

 

X =the number of shares of
Common Stock issuable upon exercise pursuant to this paragraph ‎2(e);

 

A =the Current Market Price
Per Common Share on the date on which the Holder delivers a Warrant Exercise Notice to the Company pursuant to paragraph ‎2(a);

 

B =the Exercise Price; and

 

C =the number of shares of
Common Stock as to which this Warrant is being exercised pursuant to paragraph ‎2(a).

 

If the foregoing calculation results in
zero or a negative number, then no shares of Common Stock shall be issued upon exercise pursuant to this paragraph ‎2(e).

 

3. Restrictive Legend. Certificates
representing shares of Common Stock issued pursuant to this Warrant shall bear a legend substantially in the form of the legend
set forth on the first page of this Warrant to the extent that and for so long as such legend is required pursuant to applicable
securities laws.

 

4. Reservation of Shares. The Company
hereby agrees that at all times there shall be reserved for issuance and delivery upon exercise of this Warrant such number of
its authorized but unissued shares of Common Stock or other securities of the Company from time to time issuable upon exercise
of this Warrant as will be sufficient to permit the exercise in full of this Warrant. All such shares shall be duly authorized
and, when issued upon such exercise, shall be validly issued, fully paid and non-assessable, free and clear of all liens, security
interests, charges and other encumbrances or restrictions on sale and free and clear of all preemptive rights, in each case except
restrictions on transfer contemplated by paragraph ‎3, to the extent set forth in the Note and Warrant Purchase Agreement and
to the extent created by the Holder.

 

    	5

    	 

    

 

5. Fractional Shares. No fractional
shares or scrip representing fractional shares shall be issued upon the exercise of this Warrant, and in lieu of delivery of any
such fractional share to which the Holder may be entitled upon any exercise of this Warrant, the Company shall pay to the Holder
an amount in cash equal to such fraction multiplied by the Current Market Price Per Common Share on the Business Day immediately
preceding the date on which the Holder delivers the Warrant Exercise Notice pursuant to paragraph ‎2(a).

 

6. Loss or Destruction of Warrant.
Upon receipt by the Company of evidence satisfactory to it (in the exercise of its reasonable discretion) of the loss, theft, destruction
or mutilation of this Warrant, and (in the case of loss, theft or destruction) of reasonably satisfactory indemnification, and
upon surrender and cancellation of this Warrant, if mutilated, the Company shall execute and deliver a new Warrant of like tenor
and date.

 

7. Anti-dilution Provisions.

 

(a)Common Stock Dividends,
Subdivisions or Combinations. If the Company shall at any time after the date hereof (A) declare and pay a dividend or make
a distribution on Common Stock payable in Common Stock, (B) subdivide or split the outstanding shares of Common Stock into a greater
number of shares or (C) combine or reclassify the outstanding shares of Common Stock into a smaller number of shares, then in each
such case:

 

(i)the number of Warrant Shares issuable
upon exercise of this Warrant thereafter shall be proportionately adjusted so that the exercise of this Warrant after such event
shall entitle the Holder to receive the aggregate number of shares of Common Stock that such Holder would have been entitled to
receive had such Holder exercised this Warrant immediately prior to such event; and

 

(ii)the Exercise Price thereafter shall
be adjusted to equal the product of the Exercise Price in effect immediately prior to such event multiplied by a fraction 0 the
numerator of which shall be the number of Warrant Shares issuable upon the exercise of this Warrant immediately prior to such event
and 0 the denominator of which shall be the number of Warrant Shares issuable upon the exercise of this Warrant immediately following
such event.

 

Any adjustment made pursuant to this paragraph
‎8(a) shall become effective immediately after the applicable record date in the case of a dividend or distribution and immediately
after the applicable effective date in the case of a subdivision, split, combination or reclassification.

 

    	6

    	 

    

 

(b)Certain Issuances of Common
Stock or Convertible Securities. If the Company shall issue or sell any shares of Common Stock (or options, rights, warrants
or other securities convertible into or exchangeable or exercisable for shares of Common Stock (collectively, “convertible
securities”)) (other than Excluded Securities) without consideration or at an Aggregate Offering Price that is less than
the Current Market Price Per Common Share on the last trading day preceding the date of the agreement on pricing such shares of
Common Stock (or such convertible securities), then in each such case:

 

(i)the number of Warrant Shares issuable
upon exercise of this Warrant thereafter shall be adjusted to equal the product of the number of Warrant Shares issuable upon the
exercise of this Warrant immediately prior to such record date (or issuance or sale date, as applicable) multiplied by a fraction
0 the numerator of which shall be the sum of (x) the number of shares of Common Stock outstanding on such date and (y) the number
of additional shares of Common Stock issued (or into which convertible securities may be exercised or converted) and 0 the denominator
of which shall be the sum of 0 the number of shares of Common Stock outstanding on such date and 0 the number of shares of Common
Stock that the aggregate consideration for the total number of such additional shares of Common Stock so issued (or into which
convertible securities may be exercised or converted) would purchase at a price per share equal to the Current Market Price Per
Common Share on such record date (or issuance or sale date, as applicable); and

 

(ii)the Exercise Price thereafter shall
be adjusted to equal the product of the Exercise Price in effect immediately prior to such record date (or issuance or sale date,
as applicable) multiplied by a fraction (A) the numerator of which shall be the number of Warrant Shares issuable upon the exercise
of this Warrant immediately prior to such record date (or issuance or sale date, as applicable) and (B) the denominator of which
shall be the number of Warrant Shares issuable upon the exercise of this Warrant immediately following such record date (or issuance
or sale date, as applicable).

 

Any adjustment made pursuant to this paragraph
8(b) shall become effective immediately after the applicable record date (or, if no record date is used, after the issuance or
sale date).

 

    	7

    	 

    

 

(c)Consolidation, Merger or
Sale of Assets. In the event of any consolidation of the Company with, or merger of the Company into, any other Person, any
merger of another Person into the Company (other than a merger which does not result in any reclassification, conversion, exchange
or cancellation of outstanding shares of Common Stock) or any sale or transfer of all or substantially all of the assets of the
Company to the Person formed by such consolidation or resulting from such merger, as the case may be, the Holder shall have the
right thereafter to exercise this Warrant for the kind and amount of securities, cash and/or other property receivable upon such
consolidation, merger, sale or transfer by a holder of the number of shares of Common Stock for which this Warrant may have been
exercised immediately prior to such consolidation, merger, sale or transfer. In determining the kind and amount of securities,
cash and/or other property receivable upon such consolidation, merger, sale or transfer, if the holders of Common Stock have the
right to elect as to the consideration to be received upon the consummation of such consolidation, merger, sale or transfer, then
the consideration that the Holder shall be entitled to receive upon exercise shall be deemed to be the kind and amount of consideration
received by the majority of all holders of Common Stock that affirmatively make an election (or of all such holders if none make
an election). Adjustments for events subsequent to the effective date of such a consolidation, merger, sale or transfer of assets
shall be as nearly equivalent as may be practicable to the adjustments provided for in this Warrant. In any such event, effective
provisions shall be made in the certificate or articles of incorporation of the resulting or surviving corporation, in any contract
of sale, merger, conveyance, lease, transfer or otherwise so that the provisions set forth herein for the protection of the rights
of the Holder shall thereafter continue to be applicable; and any such resulting or surviving corporation shall expressly assume
the obligation to deliver, upon exercise, such shares of stock, other securities, cash and property.

 

(d)Certain Determinations.
For purposes of any computation of any adjustment required under this paragraph 8:

 

(i)adjustments shall be made successively
whenever any event giving rise to such an adjustment shall occur;

 

(ii)if any portion of any consideration
to be received by the Company in a transaction giving rise to such an adjustment shall be in a form other than cash, the fair market
value of such non-cash consideration shall be utilized in such computation. Such fair market value shall be determined by the Board
of Directors; provided that if the Holder shall object to any such determination, the Board of Directors shall retain an
independent appraiser reasonably satisfactory to the Holder to determine such fair market value. The expense of such independent
appraiser shall be shared equally by the Company and the Holder. The Holder shall be notified promptly of any consideration other
than cash to be received by the Company and furnished with a description of the consideration and the fair market value thereof,
as determined in accordance with the foregoing provisions;

 

(iii)such calculations shall be made to
the nearest one-tenth of a cent or to the nearest hundredth of a share, as the case may be; and

 

(iv)no adjustment in the Exercise Price
or the number of Warrant Shares issuable upon exercise of the Warrant, as the case may be, shall be required if the amount of such
adjustment would be less than one-tenth of a cent or hundredth of a share, as the case may be; provided that any adjustments
which by reason of this paragraph ‎8(e)(iv) are not required to be made shall be carried forward and taken into account in
any subsequent adjustment.

 

    	8

    	 

    

 

(e)Certificates as to Adjustments.
Upon the occurrence of each adjustment to the Exercise Price and/or the number of Warrant Shares issuable upon exercise of this
Warrant, the Company shall promptly compute such adjustment in accordance with the terms hereof and furnish to the Holder a certificate
setting forth such adjustment and showing in reasonable detail the facts upon which such adjustment is based.

 

(f)Notices. In the event
that the Company shall propose at any time to effect any of the events described in paragraphs ‎(a) through ‎(e) above
that would result in an adjustment to the Exercise Price, the number of Warrant Shares issuable upon exercise of this Warrant or
a change in the type of securities or property to be delivered upon exercise of this Warrant, the Company shall send notice to
the Holder in the manner set forth in paragraph ‎9. In the case of a dividend or other distribution, such notice shall be sent
at least 10 days prior to the applicable record date and shall specify such record date and the date on which such dividend or
other distribution is to be made. In any other case, such notice shall be sent at least 15 days prior to the effective date of
any such event and shall specify such effective date. In all cases, such notice shall specify such event in reasonable detail,
including the effect on the Exercise Price and the number, kind or class of securities or other property issuable upon exercise
of this Warrant. Failure to furnish any certificate pursuant to paragraph 7(e) or to give any notice pursuant to this paragraph
7(f), or any defect in any such certificate or notice, shall not affect the legality or the validity of the adjustment of the Exercise
Price and/or the number of securities, cash and/or other property issuable upon exercise of this Warrant, or any transaction giving
rise thereto.

 

8. Notices. Any notice, demand
or delivery authorized by this Warrant shall be in writing and shall be given to the Holder or the Company, as the case may be,
at the respective addresses of the parties as set forth in the Note and Warrant Purchase Agreement, or such other address (or facsimile
number) as shall have been furnished to the party giving or making such notice, demand or delivery. Each such notice, demand or
delivery shall be deemed received on the date of receipt by the recipient thereof if received prior to 5:00 p.m. in the place of
receipt and such day is a Business Day. Otherwise, any such notice, demand or delivery shall be deemed not to have been received
until the next succeeding Business Day.

 

9. Rights of the Holder. Prior
to any exercise of this Warrant, the Holder shall not, by virtue hereof, be entitled to any rights of a shareholder of the Company,
including, without limitation, the right to vote, to receive dividends or other distributions, to exercise any preemptive right
or to receive any notice of meetings of shareholders or any notice of any proceedings of the Company except as may be specifically
provided for herein.

 

    	9

    	 

    

 

10.GOVERNING LAW. THIS WARRANT
AND ALL RIGHTS ARISING HEREUNDER SHALL BE CONSTRUED AND DETERMINED IN ACCORDANCE WITH THE INTERNAL LAWS OF THE STATE OF CALIFORNIA,
AND THE PERFORMANCE THEREOF SHALL BE GOVERNED AND ENFORCED IN ACCORDANCE WITH SUCH LAWS. 

 

11.Amendments; Waivers. Any provision
of this Warrant may be amended or waived if, and only if, such amendment or waiver is in writing and signed, in the case of an
amendment, by the Holder and the Company, or in the case of a waiver, by the party against whom the waiver is to be effective.
No failure or delay by either party in exercising any right, power or privilege hereunder shall operate as a waiver thereof nor
shall any single or partial exercise thereof preclude any other or further exercise thereof or the exercise of any other right,
power or privilege. The rights and remedies herein provided shall be cumulative and not exclusive of any rights or remedies provided
by law.

 

    	10

    	 

    

 

IN WITNESS WHEREOF, the Company has duly
caused this Warrant to be signed by its duly authorized officer and to be dated as of ___________, 2014.

 

	 	AMERICAN SHARED HOSPITAL SERVICES
	 	By:	 
	 	 	Name:
	 	 	Title:

 

Acknowledged and Agreed:

 

	[HOLDER]	 
	By:  	 	 
	 	Name:	 
	 	Title:	 

 

    	 

    	 

    

 

WARRANT EXERCISE NOTICE

 

(To be delivered prior to exercise of the
Warrant

by execution of the Warrant Exercise Subscription Form)

 

To:American Shared Hospital Services

 

The undersigned hereby notifies you of its
intention to exercise the Warrant to purchase shares of Common Stock, no par value, of American Shared Hospital Services. The undersigned
intends to exercise the Warrant to purchase ___________ shares (the “Warrant Shares”) at $______ per Warrant
Share (the Exercise Price currently in effect pursuant to the Warrant). As indicated below, the undersigned intends to pay the
aggregate Exercise Price for the Warrant Shares by wire transfer of immediately available funds or by certified or official bank
or bank cashier’s check or by reduction in the number of Warrant Shares that would otherwise be issued upon exercise pursuant
to paragraph ‎2(e) of the Warrant.

 

Date: _________________

	 	 
	 	(Signature of Owner)
	 	 
	 	(Street Address)
	 	 
	 	(City)               (State)               (Zip Code)

 

	Payment:	$                                
      wire transfer of immediately available funds
	 	 
	 	$                                
      certified or official bank or bank cashier’s check
	 	 
	 	Reduction in number of Warrant Shares

 

    	 

    	 

    

 

WARRANT EXERCISE SUBSCRIPTION FORM

 

(To be executed only upon exercise of the
Warrant

after delivery of Warrant Exercise Notice)

 

To:American Shared Hospital Services

 

The undersigned irrevocably exercises the
Warrant for the purchase of ___________ shares (the “Warrant Shares”) of Common Stock, no par value per share,
of American Shared Hospital Services (the “Company”) at $_____ per Warrant Share (the Exercise Price currently
in effect pursuant to the Warrant) and herewith makes payment of $___________ (such payment being made as specified in the undersigned’s
previously-delivered Warrant Exercise Notice), all on the terms and conditions specified in the within Warrant Certificate, surrenders
this Warrant Certificate and all right, title and interest therein to the Company and directs that the Warrant Shares deliverable
upon the exercise of this Warrant be registered or placed in the name and at the address specified below and delivered thereto.

 

Date: _________________

	 	 
	 	(Signature of Owner)
	 	 
	 	(Street Address)
	 	 
	 	(City)               (State)               (Zip Code)

 

    	 

    	 

    

 

	Securities and/or check to be issued to:  	 

 

	Please insert social security or identifying number:  	 

 

	Name:  	 

 

	Street Address:  	 

 

	City, State and Zip Code:  	 

 

Any unexercised portion of the Warrant evidenced by the within
Warrant to be issued to:

 

	Please insert social security or identifying number:  	 

 

	Name:  	 

 

	Street Address:  	 

 

	City, State and Zip Code:

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