Revenue Performance - Revenues for the three-month period ended March 31, 2022, increased by $483,000 to $4,847,000 compared to $4,364,000 for the same period in the prior year[66] - Revenues from the PBRT system increased by $508,000 to $2,039,000 for the three-month period ended March 31, 2022, driven by an increase in procedure volumes[66] - Gamma Knife revenues decreased by $84,000 to $2,808,000 for the three-month period ended March 31, 2022, due to a decrease in procedures[67] Procedure Volumes - The number of PBRT fractions increased by 397 to 1,628 for the three-month period ended March 31, 2022, compared to 1,231 for the same period in the prior year[66] - The number of Gamma Knife procedures decreased by 26 to 329 for the three-month period ended March 31, 2022, compared to 355 for the same period in the prior year[68] Cost and Income - Total costs of revenue decreased by $150,000 to $2,780,000 for the three-month period ended March 31, 2022, compared to $2,930,000 for the same period in the prior year[68] - Net income increased by $240,000 to $269,000, or $0.04 per diluted share for the three-month period ended March 31, 2022, due to increased revenues and decreased operating costs[74] Cash and Working Capital - The Company had cash, cash equivalents, and restricted cash of $8,401,000 at March 31, 2022, compared to $8,263,000 at December 31, 2021[76] - As of March 31, 2022, the Company had working capital of $10,421,000, an increase of $1,225,000 from $9,196,000 at December 31, 2021, primarily due to a decrease in accounts payable and current liabilities[77] Debt and Financing - The Company has scheduled interest and principal payments under its debt obligations of approximately $2,010,000 during the next 12 months[76] - The Company has secured a five-year $22,000,000 credit agreement with Fifth Third Bank, which refinanced its existing domestic Gamma Knife portfolio and includes a $7,000,000 revolving line of credit that has not been drawn on as of March 31, 2022[78] Commitments and Projects - Total commitments for the purchase of two MEVION S250i PBRT systems amount to $34,000,000, with delivery required no later than 2023[81] - As of March 31, 2022, the Company had commitments totaling $10,760,000 for the installation of four Leksell Gamma Knife Icon Systems and two Linear Accelerator systems, scheduled between 2022 and 2023[82] - The Company has commitments to service and maintain its Gamma Knife and PBRT equipment, totaling $9,356,000 as of March 31, 2022[84] - The Company is actively seeking sites for the second and third PBRT units but has not yet entered into agreements for placement or financing[81] - The Company expects to upgrade the Gamma Knife unit in Ecuador in the latter part of 2022, financed by DFC[82] Related Party Transactions - Related party transactions with Elekta for equipment purchases and maintenance costs were $1,232,000 and $269,000 for the three-month period ended March 31, 2022[86] Cash Flow and Obligations - The Company has cash on hand of $8,401,000 and a line of credit of $7,000,000 to fund its projects, with no significant cash requirements pending financing for the next 12 months[82] - The Company believes that cash flow from operations will be sufficient to cover service commitments and other obligations[84]

American Shared Hospital Services (NYSE:AMS) Q4 2021 Earnings Conference Call March 24, 2022 4:00 PM ET CompanyParticipants Stephanie Prince - Investor Relations-PCG Advisory Alexis Wallace - Chief Accounting Officer Craig Tagawa - President, Chief Operating Officer & Chief Financial Officer Ray Stachowiak - Chief Executive Officer Conference Call Participants Operator Good day and welcome to the American Shared Hospital Services Fourth Quarter and Year End 2021 Earnings Conference Call. All participants wi ...

Financial Data and Key Metrics Changes - Total revenue increased by 12% year-over-year to $4.476 million in Q2 2021 compared to $3.991 million in Q2 2020 [10][14] - Net income rose to $157,000 in Q2 2021 from a net loss of $483,000 in Q2 2020, marking a significant turnaround [7][16] - Gross margin improved to 35.9% of revenue, up from 22.7% in the same quarter last year, with gross margin dollars increasing by 77% to $1.607 million [11][15] Business Line Data and Key Metrics Changes - Revenue from the proton therapy system at Orlando Health increased by 10.6% to $1.549 million, despite a 17.9% decrease in total proton therapy fractions [10][14] - Gamma Knife revenue increased by 13% to $2.927 million, with procedures rising by 7.4% to 376 [10][15] - Selling and administrative costs decreased by 10% to $1.090 million, contributing to improved operating income of $352,000 compared to an operating loss of $570,000 in Q2 2020 [12][16] Market Data and Key Metrics Changes - The company reported a cash balance of $8.4 million at the end of Q2 2021, up from $4.325 million at the end of 2020, indicating improved liquidity [17] - The establishment of a $22 million credit agreement with Fifth Third Bank, which includes a $7 million revolving line of credit, enhances financial flexibility for future projects [8][9] Company Strategy and Development Direction - The company is focused on expanding its radiation therapy equipment offerings and has several projects in the pipeline, including upgrades at Gamma Knife Center Ecuador [13] - Management emphasized the importance of maintaining a positive working capital position and leveraging financial resources for future business opportunities [9][31] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's future, highlighting a positive trend in net income and increased cash reserves for investment [30][31] - The ongoing impact of the pandemic on hospital systems has been acknowledged, but management remains optimistic about future growth opportunities in radiation therapy [27][30] Other Important Information - The company completed two Cobalt-60 reloads in the first half of 2021 and is planning additional reloads based on executed contract extensions [12][13] - Shareholders' equity at June 30, 2021, was $23.714 million, slightly up from $23.650 million at the end of 2020 [17] Q&A Session Summary Question: Progress on reducing high overhead office space - Management acknowledged ongoing efforts to reduce office space costs but noted challenges due to decreased demand for office space [20][23] Question: Leads on new machinery sales - Management confirmed that there have been new leads for machinery sales and are actively pursuing these opportunities [25] Question: Pursuit of proton beam placements - Management stated that they continue to explore opportunities for proton beam placements, although such opportunities have been limited due to the pandemic [27] Question: Plans for investor exposure and road shows - Management indicated a potential for increased investor exposure and expressed a positive outlook on the company's fortunes, which may attract more interest from retail investors [30][31]

Financial Data and Key Metrics Changes - Total revenue for Q1 2021 was approximately $4.4 million, a 4.5% decline compared to $4.568 million in Q1 2020 [11][17] - Net income for Q1 2021 was $29,000, compared to a net loss of $135,000 in Q1 2020, marking a positive swing of $164,000 [19] - Gross margin increased to 32.9% of revenue in Q1 2021, up from 30.5% in Q1 2020 [13][18] Business Line Data and Key Metrics Changes - Gamma Knife revenue was $2.9 million, even with Q1 2020, while procedures decreased by 5.6% to 355 [12][18] - Proton therapy revenue decreased by 8.7% to $1.531 million, with total fractions down 26.6% to 1,231 [17][19] - Selling and administrative costs decreased by 10.5% to $1.084 million compared to Q1 2020 [19] Market Data and Key Metrics Changes - The company reported a positive working capital position of $4.2 million at the end of Q1 2021, compared to a negative $1.5 million at the end of 2020 [8] - Cash and cash equivalents increased to $5.013 million at March 31, 2021, from $4.325 million at December 31, 2020 [20] Company Strategy and Development Direction - The establishment of a $22 million credit agreement with Fifth Third Bank is aimed at enhancing long-term shareholder value and increasing growth [6][9] - The company is focusing on optimizing its cost structure and exploring new project negotiations with potential customers [9][15] Management's Comments on Operating Environment and Future Outlook - Management expects patient volumes to normalize as the pandemic recedes, which could positively impact future revenues [9] - The company is optimistic about future growth opportunities, particularly in expanding its Gamma Knife and proton therapy offerings [9][26] Other Important Information - The company completed two Cobalt-60 reloads in Q1 2021 and has several upgrades pending, including a new Gamma Knife installation in Ecuador [15] - Shareholders' equity increased to $23.844 million at March 31, 2021, compared to $23.650 million at December 31, 2020 [20] Q&A Session Summary Question: Has the company drawn down on its revolving credit facility? - Management confirmed that they have not drawn down on the revolving credit facility as there has been no need to do so [22][23] Question: Are there additional Gamma Knife units in the pipeline? - Management indicated ongoing efforts to find locations for Gamma Knife installations, with more discussions happening than in the recent past [25][26] Question: What is the status of the company's office lease? - Management acknowledged efforts to explore re-leasing options for their office space, which has approximately three years remaining on the lease [29][30]

Revenue Performance - The Company recognized revenues of approximately $4,364,000 for the three-month period ended March 31, 2021, a decrease of $204,000 compared to $4,568,000 for the same period in the prior year[64]. - Revenues from the PBRT system decreased by $145,000 to $1,531,000 for the three-month period ended March 31, 2021, primarily due to lower fractions resulting from the COVID-19 pandemic[65]. - Gamma Knife revenues remained stable at $2,892,000 for the three-month periods ended March 31, 2021 and 2020, despite a decrease in procedures offset by an increase in average reimbursement[66]. - The COVID-19 pandemic has significantly impacted business activity, leading to delays in Gamma Knife procedures and PBRT treatments, affecting overall revenue generation[63]. Procedure Statistics - The number of PBRT fractions decreased by 445 to 1,231 for the three-month period ended March 31, 2021 compared to 1,676 for the same period in the prior year[65]. - The number of Gamma Knife procedures decreased by 21 to 355 for the three-month period ended March 31, 2021 compared to 376 for the same period in the prior year[66]. Cost and Income Analysis - Total costs of revenue decreased by $244,000 to $2,930,000 for the three-month period ended March 31, 2021 compared to $3,174,000 for the same period in the prior year[67]. - Depreciation and amortization decreased by $449,000 to $1,198,000 for the three-month period ended March 31, 2021 compared to $1,647,000 for the same period in the prior year[68]. - Net income increased by $164,000 to $29,000, or $0.00 per diluted share for the three-month period ended March 31, 2021 compared to a net loss of $135,000, or $0.02 per diluted share for the same period in the prior year[71]. Financial Position - As of March 31, 2021, the Company had cash, cash equivalents, and restricted cash of $5,013,000, an increase of $688,000 from $4,325,000 at December 31, 2020, primarily due to cash from operating activities of $2,783,000[73]. - As of March 31, 2021, the Company had shareholders' equity of $23,844,000, working capital of $4,163,000, and total assets of $44,047,000[74]. Debt and Commitments - The Company has scheduled interest and principal payments under its debt obligations of approximately $1,209,000 during the next 12 months[73]. - The Company has commitments to purchase two MEVION S250i PBRT systems for $34,000,000, with delivery required no later than 2023[76]. - Total Gamma Knife and LINAC commitments as of March 31, 2021 were $10,860,000, with upgrades expected to occur between 2022 and 2023[77]. - The Company has a commitment from DFC to finance the upgrade of the Gamma Knife unit in Ecuador, expected in Q3 2021[77]. - Total service commitments as of March 31, 2021 were $10,272,000, with cash flow from operations expected to cover these payments[79]. Financial Instruments - The Company does not hold or issue derivative instruments for trading purposes and has no exposure to off-balance sheet financial transactions[81].

Financial Performance - The Company reported total revenue of $11.67 million for the year ended December 31, 2020, representing 65.4% of total revenue from Gamma Knife services[21] - The Gamma Knife business accounted for 65.4% of total revenue in 2020, slightly down from 65.8% in 2019[21] - One customer accounted for approximately 35% of the Company's total revenue in 2020, down from 30% in 2019[31] Impairment and Assets - The Company recognized an impairment loss of $8.26 million on assets, including six Gamma Knife units and related costs, for the year ended December 31, 2020[18] - The Company has $2.25 million in deposits for two MEVION S250i PBRT systems, which were determined to be impaired, resulting in a total impairment of $3.86 million related to the proton therapy business[26] Product and Market Expansion - The Company continues to expand its product offerings to include advanced linear accelerators with MRI and PET imaging technologies, targeting a more receptive market segment[23] - The Company operates thirteen Gamma Knife units in the U.S. and two in South America, with plans for further expansion in the radiation therapy market[17] - The Company has established subsidiaries in Peru and Ecuador to provide Gamma Knife services, enhancing its international presence[12] Pricing and Reimbursement - The average Medicare reimbursement rate for Gamma Knife procedures was $9,600 in 2021, unchanged from 2020[46] - The RO APM, effective January 1, 2022, will change the payment methodology for radiation services, impacting approximately 30% of radiation oncology patients[43] - PBRT patients with Medicare as their primary insurer comprise an estimated 45% to 50% of total radiation therapy patients treated[42] - The Company’s Gamma Knife contracts typically range from $6,000 to $9,300 per procedure, with no minimum volume guarantees required from customers[30] Financing and Contracts - The Company’s financing for Gamma Knife units is predominantly fully amortized over an 84-month period, collateralized by equipment and customer contracts[35] - The Company does not have customer contracts for its second and third PBRT units, indicating a need for market expansion[38] - The Company’s ability to secure additional customers is dependent on effective competition against manufacturers selling directly to potential customers[40] Employment and Compliance - The Company employed a total of 21 full-time employees as of December 31, 2020, with 10 in the United States, 5 in Peru, and 6 in Ecuador[59] - The Company believes it is in compliance with various federal and state regulations, including the federal anti-kickback statute and the Federal False Claims Act[51][54] - The Company is subject to legislative changes affecting Medicare payments, including a 2% reduction to providers that has been in effect since April 2013 and will continue through 2027 unless further Congressional action is taken[50] - The Company believes that the evolving interpretations of the federal anti-kickback statute may impact its operations, although it currently believes it is compliant[51] Insurance and Regulatory Matters - The Company maintains a comprehensive insurance program covering the value of its property and equipment, which it believes is reasonable[57] - The Company’s Gamma Knife units contain Cobalt 60 radioactive sources, and the medical centers are responsible for obtaining necessary licenses from regulatory agencies[56] - The Company’s operations may be affected by Certificate of Need (CON) requirements in various jurisdictions, which can be time-consuming and costly[55] - The Company’s Gamma Knife centers in Peru and Ecuador are operated by independent contractors, and the Company maintains adequate insurance coverage for these operations[58] Executive Team - The Company’s executive team includes Raymond C. Stachowiak as CEO, Craig K. Tagawa as President and CFO, and Ernest R. Bates as Senior VP[60][61][62]

UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 _______________________ FORM 10-Q (Mark One) ☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the quarterly period ended September 30, 2020 or ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from _______________ to _______________. Commission file number 001-08789 ________________________ American Shared Hospital Services (Exa ...