[PART I – FINANCIAL INFORMATION](index=2&type=section&id=PART%20I%20%E2%80%93%20FINANCIAL%20INFORMATION) [Item 1. Financial Statements](index=2&type=section&id=Item%201.%20Financial%20Statements) This section presents American Shared Hospital Services' unaudited condensed consolidated financial statements as of June 30, 2025, including balance sheets, statements of operations, shareholders' equity, and cash flows, with detailed notes on presentation basis, significant accounting policies, acquisitions, debt, leases, and other financial details Condensed Consolidated Balance Sheets Summary (in thousands) | | June 30, 2025 | December 31, 2024 | | :--- | :--- | :--- | | **Total Current Assets** | $24,433 | $26,258 | | **Total Assets** | $63,494 | $60,197 | | **Total Current Liabilities** | $20,860 | $10,405 | | **Total Liabilities** | $34,646 | $30,170 | | **Total Shareholders' Equity** | $28,848 | $30,027 | Condensed Consolidated Statements of Operations Summary (in thousands, except per share data) | | Three Months Ended June 30 | Six Months Ended June 30 | | :--- | :--- | :--- | | | **2025** | **2024** | **2025** | **2024** | | **Total Revenue** | $7,071 | $7,056 | $13,183 | $12,272 | | **Gross Profit** | $1,630 | $2,468 | $2,572 | $4,611 | | **Operating Loss** | ($544) | ($1) | ($1,843) | ($86) | | **Net (Loss) Income Attributable to ASHS** | ($280) | $3,602 | ($905) | $3,721 | | **Diluted (Loss) Earnings Per Share** | ($0.04) | $0.55 | ($0.14) | $0.57 | Condensed Consolidated Statements of Cash Flows Summary (in thousands) | | Six Months Ended June 30, 2025 | Six Months Ended June 30, 2024 | | :--- | :--- | :--- | | **Net Cash Provided by (Used in) Operating Activities** | $2,131 | ($579) | | **Net Cash Used in Investing Activities** | ($5,916) | ($2,036) | | **Net Cash Provided by Financing Activities** | $3,841 | $3,293 | | **Net Change in Cash, Cash Equivalents, and Restricted Cash** | $56 | $678 | - The company identified two reportable segments: leasing and direct patient services, with the latter expanding through the Rhode Island (RI) acquisition and operations of a new facility in Mexico[37](index=37&type=chunk)[38](index=38&type=chunk) - In Q2 2024, a net bargain purchase gain of **$3.679 million** related to the RI acquisition significantly impacted current period earnings[9](index=9&type=chunk)[86](index=86&type=chunk)[126](index=126&type=chunk) - A new tax law, the One Big Beautiful Bill Act (OBBBA), was enacted on July 4, 2025 (post-reporting period), and the company is evaluating its impact, with adjustments to be reflected in Q3 2025[88](index=88&type=chunk)[91](index=91&type=chunk) [Item 2. Management's Discussion and Analysis of Financial Condition and Results of Operations](index=25&type=section&id=Item%202.%20Management%27s%20Discussion%20and%20Analysis%20of%20Financial%20Condition%20and%20Results%20of%20Operations) Management discusses Q2 2025 financial performance, noting a slight increase in total revenue driven by the direct patient services segment, offsetting a decline in the leasing segment, and covers revenue drivers, cost fluctuations, RI acquisition impact, liquidity, capital resources, debt obligations, and significant new equipment commitments [Second Quarter 2025 Results](index=29&type=section&id=Second%20Quarter%202025%20Results) Total revenue for Q2 2025 remained flat year-over-year at **$7.1 million**, with direct patient services revenue increasing by **$0.343 million** offsetting a **$0.328 million** decrease in leasing revenue, resulting in a net loss of **$0.28 million** or **($0.04)** per share, contrasting sharply with Q2 2024's **$3.6 million** net income primarily due to a one-time RI acquisition bargain purchase gain recognized in the prior year Segment Revenue (in millions) | Revenue Segment | Q2 2025 | Q2 2024 | H1 2025 | H1 2024 | | :--- | :--- | :--- | :--- | :--- | | Leasing | $3.57 | $3.90 | $6.56 | $8.15 | | Direct Patient Services | $3.50 | $3.16 | $6.62 | $4.12 | | **Total** | **$7.07** | **$7.06** | **$13.18** | **$12.27** | Key Operating Metrics (Number of Treatments) | Operating Metric | Q2 2025 | Q2 2024 | H1 2025 | H1 2024 | | :--- | :--- | :--- | :--- | :--- | | PBRT Fractions | 1,114 | 1,236 | 1,945 | 2,512 | | Gamma Knife Treatments | 264 | 340 | 472 | 613 | | Radiation Therapy (RI & Puebla) | 6,320 | 2,599 | 13,046 | 2,599 | - The decline in leasing revenue was primarily due to reduced Gamma Knife and PBRT treatment volumes, partly attributable to expiring customer contracts[112](index=112&type=chunk) - Growth in direct patient services revenue was driven by the full-period contribution from RI (acquired May 2024) and the new Puebla facility in Mexico[112](index=112&type=chunk) - Net loss for Q2 2025 was **$0.28 million**, compared to a net income of **$3.602 million** in the prior-year period, with the latter including a **$3.679 million** bargain purchase gain[9](index=9&type=chunk)[130](index=130&type=chunk) [Liquidity and Capital Resources](index=31&type=section&id=Liquidity%20and%20Capital%20Resources) As of June 30, 2025, the company held **$11.3 million** in cash, cash equivalents, and restricted cash, with working capital significantly decreasing from **$15.9 million** at year-end 2024 to **$3.6 million**, primarily due to revolving credit line utilization and increased current portion of long-term debt, though the company believes existing cash, operating cash flow, and available credit are sufficient for the next 12 months' debt and operating needs - As of June 30, 2025, total cash, cash equivalents, and restricted cash amounted to **$11.331 million**[131](index=131&type=chunk) - Working capital decreased by **$12.28 million** from December 31, 2024, to **$3.573 million**, primarily due to a **$5 million** revolving credit line draw and reclassification of long-term debt to current liabilities[132](index=132&type=chunk) - As of June 30, 2025, the company was not in compliance with its maximum financed debt to EBITDA ratio covenant but regained compliance on July 1, 2025[50](index=50&type=chunk)[137](index=137&type=chunk) [Commitments](index=35&type=section&id=Commitments) As of June 30, 2025, the company had significant commitments totaling **$8.4 million** for the purchase and installation of three Gamma Knife Esprit systems and two LINAC systems, in addition to **$11.9 million** in equipment service and maintenance commitments, with plans to finance these purchases and confidence in cash flow and available credit to cover service fees - The company has **$8.385 million** in commitments for the purchase of three Esprit systems and two LINAC systems[73](index=73&type=chunk)[145](index=145&type=chunk) - Total service and maintenance commitments for equipment amount to **$11.928 million**[75](index=75&type=chunk)[147](index=147&type=chunk) [Item 3. Quantitative and Qualitative Disclosures about Market Risk](index=36&type=section&id=Item%203.%20Quantitative%20and%20Qualitative%20Disclosures%20about%20Market%20Risk) The company states that as of June 30, 2025, it does not hold or issue derivative instruments for trading purposes, nor does it have significant long-term market-sensitive investments, and has no exposure to entities designed to facilitate off-balance sheet financial transactions or similar arrangements - As of June 30, 2025, the company does not use derivative instruments for trading purposes and has no significant market-sensitive investments[151](index=151&type=chunk) [Item 4. Controls and Procedures](index=37&type=section&id=Item%204.%20Controls%20and%20Procedures) Management concluded that the company's disclosure controls and procedures were ineffective as of June 30, 2025, due to previously disclosed material weaknesses in internal control over financial reporting, specifically the lack of a sufficient number of experienced personnel, with a remediation plan underway including hiring a new CFO and accounting manager, and internalizing outsourced billing processes - Disclosure controls and procedures were deemed ineffective as of June 30, 2025, due to material weaknesses in internal control[152](index=152&type=chunk) - The material weakness relates to the lack of a sufficient number of personnel with the necessary experience to maintain an appropriate control environment[152](index=152&type=chunk) - Remediation efforts include the appointment of a new CFO (December 2024), hiring an accounting manager (March 2025), and plans to internalize the billing cycle for the Rhode Island facility by Q4 2025[154](index=154&type=chunk) [PART II – OTHER INFORMATION](index=38&type=section&id=PART%20II%20%E2%80%93%20OTHER%20INFORMATION) [Item 1. Legal Proceedings](index=38&type=section&id=Item%201.%20Legal%20Proceedings.) The company reported no legal proceedings during this period - The company reported no legal proceedings[158](index=158&type=chunk) [Item 1A. Risk Factors](index=38&type=page&id=Item%201A.%20Risk%20Factors) The company stated that no material changes occurred to the risk factors previously disclosed in its annual report on Form 10-K for the year ended December 31, 2024, during this reporting period - No material changes to risk factors occurred during this reporting period[159](index=159&type=chunk)

Financial Data and Key Metrics Changes - In Q2 2025, total revenue increased by 16% sequentially to $7.1 million compared to $6.1 million in Q1 2025 [17] - Adjusted EBITDA for Q2 2025 was $1.7 million, up from $949,000 in Q1 2025 [11][21] - Net loss for Q2 2025 was $280,000, an improvement from a net loss of $625,000 in Q1 2025 [21] Business Line Data and Key Metrics Changes - Revenue from the Direct Patient Services segment was $3.5 million in Q2 2025, a 12% increase from $3.1 million in Q2 2024 [18] - Revenue from the equipment leasing segment decreased to $3.6 million from $3.9 million in Q2 2024 [18] - Gamma Knife revenue increased by 25% from Q1 2025 to $2.6 million in Q2 2025, but was down about 5% compared to Q2 2024 [19] Market Data and Key Metrics Changes - The company continues to see growth in international markets, particularly with the Gamma Knife centers in Peru and Ecuador, and the new center in Puebla, Mexico [13] - The acquisition of Rhode Island cancer treatment centers has significantly contributed to revenue growth [10][12] Company Strategy and Development Direction - The company is transitioning from a cancer treatment equipment leasing focus to a more patient-centric service model, which is expected to drive long-term growth [6][7] - Plans to expand operations include building a fourth radiation therapy treatment center in Bristol, Rhode Island, and a proton beam radiation therapy center [15] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the long-term growth trajectory, emphasizing the importance of focusing on overall growth opportunities [8][16] - The company anticipates fluctuations in treatment volumes but remains optimistic about steady growth in the overall business [11][16] Other Important Information - The company ended Q2 2025 with cash and cash equivalents of $11.3 million, consistent with the end of 2024 [25] - Shareholders' equity was $24.5 million, down from $25.2 million at the end of 2024 [26] Q&A Session Summary Question: Are there any pre-opening activities for the new locations in Rhode Island? - Management confirmed the addition of three full-time radiation oncologists to support the new centers, which will enhance service delivery [30][31] Question: Will these activities benefit the new centers? - Management affirmed that there are economies of scale with the expansion within the Rhode Island marketplace [33]

[Financial Highlights and Management Commentary](index=1&type=section&id=Financial%20Highlights%20and%20Management%20Commentary) This section covers key financial performance and management's strategic outlook [Key Financial Highlights](index=1&type=section&id=Key%20Financial%20Highlights) American Shared Hospital Services reported a **16% sequential revenue increase** in Q2 2025, driven by strong Gamma Knife and LINAC performance, despite flat year-over-year total revenue Q2 2025 Revenue Performance vs. Prior Periods | Revenue Category | Sequential Change (vs Q1 2025) | Year-over-Year Change (vs Q2 2024) | | :--- | :--- | :--- | | **Total Revenue** | ▲ 16% | ▲ 0.2% | | **Gamma Knife Revenue** | ▲ 25% | ▼ 5% | | **LINAC Revenue** | ▲ 7% | ▲ 34% | | **Proton Beam Radiation Therapy Revenue** | ▲ 17% | ▼ 21% | [Management Commentary](index=1&type=section&id=Management%20Commentary) Management expressed optimism for growth, focusing on direct patient services, operational efficiencies, and strategic acquisitions, highlighting diversification success - The CEO highlighted a focus on expanding the business model and operational enhancements, with expected growth from a new Esprit system in Guadalajara, Mexico, and expansion in Rhode Island[2](index=2&type=chunk) - The CFO emphasized the positive momentum from the growth strategy, which focuses on shifting from a traditional leasing model to being a direct provider of radiation therapy services[2](index=2&type=chunk) - The Executive Chairman noted four years of consecutive revenue growth and three years of sustained profitability, underscoring the success of recent acquisitions and the ongoing pursuit of additional strategic tuck-in acquisitions[4](index=4&type=chunk) [Financial Results](index=2&type=section&id=Financial%20Results) This section details the company's financial performance for Q2 and year-to-date 2025, including revenue, gross margin, and net income [Second Quarter 2025 Performance (Three Months Ended June 30, 2025)](index=2&type=section&id=Second%20Quarter%202025%20Performance%20(Three%20Months%20Ended%20June%2030%2C%202025)) Q2 2025 revenue was **$7.1 million**, up **0.2%** year-over-year, but the company reported a **net loss of $280,000** due to lower volumes and the absence of a prior-year bargain purchase gain Q2 2025 vs. Q2 2024 Financial Summary (in US Dollars) | Metric | Q2 2025 | Q2 2024 | Change | | :--- | :--- | :--- | :--- | | Revenue | $7,071,000 | $7,056,000 | ▲ 0.2% | | Gross Margin | $1,630,000 | $2,468,000 | ▼ 34.0% | | Net (Loss)/Income | $(280,000) | $3,602,000 | - | | Diluted EPS | $(0.04) | $0.55 | - | | Adjusted EBITDA | $1,701,000 | $2,010,000 | ▼ 15.4% | - Revenue from the direct patient services segment grew **11% to $3.5 million**, primarily due to the Rhode Island centers and the new facility in Puebla, Mexico[6](index=6&type=chunk) - Revenue from the medical equipment leasing segment fell **8% to $3.6 million** due to lower Gamma Knife volumes from expired contracts and decreased PBRT volumes[7](index=7&type=chunk) - The net loss in Q2 2025 contrasts with a large net income in Q2 2024, which included a **$3,679,000 net bargain purchase gain** from the RI Acquisition[9](index=9&type=chunk) [Year-to-Date 2025 Performance (Six Months Ended June 30, 2025)](index=3&type=section&id=Year-to-Date%202025%20Performance%20(Six%20Months%20Ended%20June%2030%2C%202025)) H1 2025 revenue increased **7% to $13.2 million**, driven by direct patient services, but resulted in a **net loss of $905,000** compared to prior year's profit H1 2025 vs. H1 2024 Financial Summary (in US Dollars) | Metric | H1 2025 | H1 2024 | Change | | :--- | :--- | :--- | :--- | | Revenue | $13,183,000 | $12,272,000 | ▲ 7.4% | | Gross Margin | $2,572,000 | $4,611,000 | ▼ 44.2% | | Net (Loss)/Income | $(905,000) | $3,721,000 | - | | Diluted EPS | $(0.14) | $0.57 | - | | Adjusted EBITDA | $2,650,000 | $3,754,000 | ▼ 29.4% | - Direct patient services revenue grew **61% to $6.6 million**, while leasing segment revenue decreased to **$6.6 million** due to expired contracts, equipment downtime, and lower PBRT volumes[11](index=11&type=chunk)[12](index=12&type=chunk) - The net loss for the first half of 2025 is compared against a net income in H1 2024 that included a **$3,679,000 net bargain purchase gain**[14](index=14&type=chunk) [Balance Sheet Highlights](index=3&type=section&id=Balance%20Sheet%20Highlights) This section provides a snapshot of the company's financial position, including cash, total assets, and shareholders' equity [Balance Sheet Summary](index=3&type=section&id=Balance%20Sheet%20Summary) As of June 30, 2025, cash and equivalents remained stable at **$11.3 million**, total assets increased to **$63.5 million**, and shareholders' equity was **$24.5 million** Balance Sheet Data (Unaudited, in US Dollars) | Metric | June 30, 2025 | December 31, 2024 | | :--- | :--- | :--- | | Cash, cash equivalents and restricted cash | $11,331,000 | $11,275,000 | | Total assets | $63,494,000 | $60,197,000 | | Shareholders' equity (excluding NCI) | $24,481,000 | $25,183,000 | | Equity per outstanding share | $3.78 | $3.92 | [Supplementary Information](index=3&type=section&id=Supplementary%20Information) This section provides details on the upcoming conference call, non-GAAP financial measures, and condensed consolidated financial statements [Conference Call Information](index=3&type=section&id=Conference%20Call%20Information) The company scheduled a conference call for August 13, 2025, at 1:00 PM ET to discuss Q2 2025 financial results, with replay options available - A conference call to discuss Q2 2025 results was scheduled for 1:00 pm ET on the day of the earnings release[16](index=16&type=chunk) - Details for participation, including phone numbers and a webcast link, were provided, and a replay will be available through August 20, 2025[17](index=17&type=chunk)[18](index=18&type=chunk) [Non-GAAP Financial Measures](index=5&type=section&id=Non-GAAP%20Financial%20Measures) Adjusted EBITDA is used as a non-GAAP measure to assess core operational performance, excluding non-recurring items, with a detailed reconciliation provided - Adjusted EBITDA is defined as net income (loss) adjusted for interest, taxes, depreciation, amortization, stock-based compensation, bargain purchase gains, and asset write-down costs[22](index=22&type=chunk) - Management uses this non-GAAP measure for period-to-period comparisons, believing it provides supplemental information on the performance of the recurring core business[23](index=23&type=chunk) Reconciliation of GAAP Net (Loss) Income to Non-GAAP Adjusted EBITDA (in US Dollars) | | Three months ended June 30, | Six months ended June 30, | | :--- | :--- | :--- | :--- | | | **2025** | **2024** | **2025** | **2024** | | **Net (loss) income** | **$(280,000)** | **$3,602,000** | **$(905,000)** | **$3,721,000** | | Adjustments | $1,981,000 | $(1,592,000) | $3,555,000 | $(133,000) | | **Adjusted EBITDA** | **$1,701,000** | **$2,010,000** | **$2,650,000** | **$3,754,000** | [Condensed Consolidated Financial Statements](index=6&type=section&id=Condensed%20Consolidated%20Financial%20Statements) This section presents unaudited condensed consolidated statements of operations and balance sheet data for the reported periods Condensed Consolidated Statements of Operations (Unaudited, in US Dollars) | | Three months ended June 30, | Six months ended June 30, | | :--- | :--- | :--- | :--- | :--- | | | **2025** | **2024** | **2025** | **2024** | | **Revenues** | $7,071,000 | $7,056,000 | $13,183,000 | $12,272,000 | | **Gross margin** | $1,630,000 | $2,468,000 | $2,572,000 | $4,611,000 | | **Operating (loss)** | $(544,000) | $(1,000) | $(1,843,000) | $(86,000) | | **Net (loss) income attributable to AMS** | $(280,000) | $3,602,000 | $(905,000) | $3,721,000 |

Core Viewpoint - American Shared Hospital Services reported a 16% sequential increase in total revenue for Q2 2025, driven by growth in treatment volumes and expansion of services [2][5]. Financial Performance - Q2 2025 revenue reached $7,071,000, a 0.2% increase compared to Q2 2024, attributed to expanded radiation therapy services [6]. - Revenue from direct patient services was $3,500,000, an 11% increase year-over-year, primarily due to acquisitions in Rhode Island and the new facility in Puebla, Mexico [6]. - The medical equipment leasing segment saw an 8% decrease in revenue to $3,571,000, impacted by lower Gamma Knife volumes and the expiration of customer contracts [7]. - Proton beam radiation therapy revenue decreased to $1,921,000 from $2,420,000 in the prior year, reflecting cyclical fluctuations [7]. Treatment Volume and Revenue Breakdown - Radiation therapy revenue for Q2 2025 was $2,541,000, up from $1,892,000 in Q2 2024, driven by the Rhode Island centers and Puebla operations [8]. - Gamma Knife revenue increased by 25% sequentially but decreased by 5% compared to Q2 2024 [5]. - LINAC revenue grew by 7% sequentially and 34% year-over-year [5]. - Proton beam radiation therapy revenue increased by 17% sequentially but decreased by 21% compared to Q2 2024 [5]. Profitability and Loss - The company reported a net loss of $280,000 or $0.04 per share for Q2 2025, compared to a net income of $3,602,000 or $0.55 per diluted share in Q2 2024 [9]. - Adjusted EBITDA for Q2 2025 was $1,701,000, down from $2,010,000 in Q2 2024 [9]. Long-term Growth Strategy - The CEO emphasized a focus on expanding the business model and operational enhancements, with expectations for growth from new installations in Mexico and recent approvals for new treatment centers in Rhode Island [4]. - The company has experienced four consecutive years of revenue growth and three years of sustained profitability, with ongoing strategic acquisitions to bolster growth potential [4]. Balance Sheet Highlights - As of June 30, 2025, cash and cash equivalents totaled $11,331,000, slightly up from $11,275,000 at the end of 2024 [14]. - Shareholders' equity was $24,481,000 or $3.78 per share, down from $25,183,000 or $3.92 per share at the end of 2024 [14].

Financial Data and Key Metrics Changes - For Q1 2025, total revenue increased by 17% to $6.1 million compared to $5.2 million in Q1 2024 [16] - Adjusted EBITDA for Q1 2025 was $949,000, down from $1.75 million in Q1 2024 due to lower procedure volume [19] - Net loss for Q1 2025 was $625,000 or $0.10 per diluted share, compared to net income of $119,000 or $0.02 per diluted share in Q1 2024 [19] Business Line Data and Key Metrics Changes - Revenue from the Direct Patient Services segment was $3.1 million for Q1 2025, a 224% increase from $963,000 in Q1 2024, driven by the Rhode Island acquisition and operations in Puebla, Mexico [16] - Revenue from the equipment leasing segment decreased to $3 million from $4.3 million in Q1 2024 [16] - Gamma Knife revenue declined by 18% to $2.1 million in Q1 2025, with a 24% decrease in procedures [17] - Proton Beam Radiation Therapy revenue decreased by 38% to $1.6 million, with a 35% decrease in treatment fractions [17] Market Data and Key Metrics Changes - The company is expanding its international business segment, with centers in Peru, Ecuador, and Puebla, Mexico, which are expected to drive growth [12] - The Rhode Island acquisition represents a significant step in expanding the company's footprint in the U.S. market [13] Company Strategy and Development Direction - The company is transitioning from a cancer treatment equipment leasing focus to a more patient-centric service model, which is expected to yield long-term growth [6] - Upcoming projects include the development of a fourth radiation therapy center in Rhode Island and the first proton beam radiation therapy facility in the state [27][28] - The company is optimistic about its growth strategy and the potential for significant shareholder value [9] Management's Comments on Operating Environment and Future Outlook - Management acknowledges fluctuations in treatment volumes but remains confident in long-term growth prospects [15] - The company is focused on building strong momentum and executing its growth strategy despite short-term challenges [27] Other Important Information - The company ended Q1 2025 with cash and cash equivalents of $11.5 million, slightly up from $11.3 million at the end of 2024 [19] - Shareholders' equity was $24.7 million or $3.82 per outstanding share, down from $25.2 million or $3.92 per share at the end of 2024 [19] Q&A Session Summary Question: Impact of lower procedure numbers and potential regulatory changes - Management believes there is minimal risk from changes in Medicaid reimbursements, as most revenue comes from private insurers and Medicare [22][24] Question: Flexibility in managing fixed costs with new center openings - Management confirmed that expanding the direct patient services segment will provide more control over activities and patient growth [25]

Financial Data and Key Metrics Changes - For Q1 2025, total revenue increased by 17% to $6.1 million compared to $5.2 million in Q1 2024 [16] - Adjusted EBITDA for Q1 2025 was $949,000, down from $1.75 million in Q1 2024 due to lower procedure volume [7][20] - Net loss for Q1 2025 was $625,000 or $0.10 per diluted share, compared to net income of $119,000 or $0.02 per diluted share in Q1 2024 [20] Business Line Data and Key Metrics Changes - Revenue from the Direct Patient Services segment was $3.1 million for Q1 2025, a 224% increase from $963,000 in Q1 2024, driven by the Rhode Island acquisition and operations in Puebla, Mexico [16][17] - Revenue from the equipment leasing segment decreased to $3 million from $4.3 million in Q1 2024 [17] - Gamma Knife revenue declined by 18% to $2.1 million, with a 24% decrease in procedures [18] - Proton Beam Radiation Therapy revenue decreased by 38% to $1.6 million, with a 35% decrease in treatment fractions [18] Market Data and Key Metrics Changes - The company has established Gamma Knife centers in Peru and Ecuador, with a new center in Puebla, Mexico, enhancing its international presence [12] - The Rhode Island acquisition represents a significant expansion in the U.S. market, with plans for a fourth radiation therapy center and the first proton beam facility in the state [13][14] Company Strategy and Development Direction - The company is transitioning from a cancer treatment equipment leasing focus to a more patient-centric service model, aiming for long-term profitable growth [6][8] - The acquisition of Rhode Island centers and international expansion are key components of the growth strategy [10][12] - Upcoming projects include a new center in Rhode Island and a joint venture for a Gamma Knife center in Guadalajara, Mexico, which is expected to generate revenue by the end of the year [12][14] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the long-term growth potential despite short-term fluctuations in treatment volumes [15][28] - The company is optimistic about the impact of staffing strategies and upgraded technology on future treatment volumes and profitability [11][15] - Management does not foresee significant risks from potential changes in Medicaid reimbursement rates, as most revenue comes from private insurers and Medicare [23][24] Other Important Information - The company maintains a strong balance sheet with cash and cash equivalents of $11.5 million as of March 31, 2025 [20] - Shareholders' equity was $24.7 million, reflecting a slight decrease from the previous quarter [20] Q&A Session Summary Question: Impact of lower procedure numbers and potential regulatory changes - Management indicated that changes in Medicaid reimbursement are not expected to significantly impact the company, as most revenue is derived from private insurers and Medicare [23][24] Question: Flexibility in managing fixed costs with new center openings - Management confirmed that expanding the Direct Patient Services segment will provide more control over activities and patient growth, enhancing fixed cost absorption [25]

Revenue and Financial Performance - The Company recognized leasing revenue of approximately $2,991,000 for the three-month period ended March 31, 2025, compared to $4,253,000 for the same period in 2024, with PBRT services contributing approximately $1,642,000 and $2,649,000, respectively [97]. - Direct patient services revenues for the three-month period ended March 31, 2025, were approximately $3,121,000, a significant increase from $963,000 in the same period of 2024 [100]. - Revenues increased by $896,000 to $6,112,000 for Q1 2025 compared to $5,216,000 for Q1 2024 [107]. - Revenues from the leasing segment decreased by $1,262,000 to $2,991,000 due to lower Gamma Knife volumes and the expiration of two customer contracts [107]. - Direct patient services revenue increased by $2,158,000 to $3,121,000, primarily driven by the RI Companies following the acquisition on May 7, 2024 [107]. - Radiation therapy revenues from the acquired facilities and the Puebla facility totaled $2,374,000 for Q1 2025, compared to $0 for Q1 2024 [108]. - Total costs of revenue increased by $2,097,000 to $5,170,000 for Q1 2025 compared to $3,073,000 for Q1 2024 [113]. - Net loss attributable to American Shared Hospital Services increased by $744,000 to a loss of $625,000, or $0.10 per diluted share for Q1 2025 [123]. Assets and Liabilities - As of March 31, 2025, accounts receivable balances under ASC 606 were $6,120,000, compared to $1,882,000 as of March 31, 2024 [100]. - Working capital decreased by $4,821,000 to $11,032,000 as of March 31, 2025, compared to $15,853,000 at December 31, 2024 [125]. - The Company had cash, cash equivalents, and restricted cash of $11,491,000 as of March 31, 2025, an increase of $216,000 from December 31, 2024 [124]. - Long-term debt was $18,372,000 as of March 31, 2025, compared to $18,462,000 at December 31, 2024 [129]. - As of March 31, 2025, the Company had long-term debt of $19,926,000 on its condensed consolidated balance sheets [136]. Debt and Financing - The DFC Loan has a first tranche outstanding amount of $1,642,000 with a fixed interest rate of 3.67% and a second tranche of $1,806,000 at 7.49% [131]. - Interest expense increased by $84,000 to $433,000 for Q1 2025 due to increased borrowings [119]. - The Company is in compliance with all covenants related to the DFC Loan as amended and waived as of March 31, 2025 [133]. - The Company received a waiver and amendment from DFC for certain covenants as of December 31, 2023, and through December 31, 2024 [132]. Commitments and Obligations - Total commitments for purchasing and installing three Leksell Gamma Knife Esprit Systems and two Linear Accelerator systems amounted to $9,618,000 as of March 31, 2025 [138]. - The Company has commitments for service and maintenance of its Gamma Knife, LINAC, and PBRT equipment totaling $12,252,000 as of March 31, 2025 [140]. - The Company has an obligation to maintain a minimum fixed charge coverage ratio of 1.25 and a maximum funded debt to EBITDA ratio of 3.0 to 1.0 under the Credit Agreement [130]. Operational Developments - The Company acquired 60% of the equity interests of the RI Companies on May 7, 2024, which operate three radiation therapy facilities in Rhode Island [90]. - The Company operates ten domestic Gamma Knife units and one PBRT system in the United States as of March 31, 2025 [96]. - The Company’s facilities in Rhode Island, Peru, Ecuador, and Mexico are considered direct patient services, where contracts exist between the Company and individual patients [90]. - The approximate CMS reimbursement rates for PBRT treatments in 2025 are $578 for simple treatments and $1,276 for intermediate and complex treatments [92]. - The Company’s revenue recognition policies are based on ASC 842 and ASC 606, with revenues recognized when services are rendered and collectability is reasonably assured [96]. Related Party Transactions - The Company recorded total related party transactions of $1,558,000 for the three months ended March 31, 2025, compared to $2,586,000 for the same period in 2024 [142]. Equipment and Salvage Value - The Company has not assigned any salvage value to its PBRT or LINAC equipment as of March 31, 2025 [101].

Core Viewpoint - American Shared Hospital Services reported a 17% year-over-year revenue growth for Q1 2025, driven by strategic expansion and operational strength despite lower treatment volumes and some seasonality [2][5][6]. Financial Performance - Q1 2025 revenue increased to $6.1 million from $5.2 million in Q1 2024, reflecting a 17% growth [6]. - Direct patient services revenue surged by 224% to $3.1 million, primarily due to the acquisition of Rhode Island centers and the new facility in Puebla, Mexico [5][6]. - Revenue from the medical equipment leasing segment decreased to $3.0 million from $4.3 million, attributed to lower Gamma Knife volumes and the expiration of two customer contracts [7]. - Total proton beam radiation therapy revenue fell to $1.6 million from $2.6 million due to normal cyclical fluctuations [7]. - Radiation therapy revenue reached $2.4 million for Q1 2025, compared to $0 in Q1 2024, driven by the acquisition of Rhode Island facilities and the launch in Puebla, Mexico [8]. - Gross margin for Q1 2025 was $942,000, down from $2.1 million in Q1 2024, primarily due to lower treatment volumes [8]. - The net loss attributable to the company was $625,000, or $0.10 per share, compared to a net income of $119,000, or $0.02 per diluted share, in Q1 2024 [8][10]. Operational Highlights - The company has begun to see an increase in treatment volumes in April 2025 and expects further recovery in the latter half of the year [3]. - Successful acquisition of Rhode Island radiation therapy treatment centers and the opening of a facility in Puebla, Mexico are key growth drivers [3]. - The company is exploring additional acquisition opportunities and anticipates closing on one within the fiscal year [3]. - The linear accelerator business reported $2.4 million in revenue for Q1 2025, compared to zero in Q1 2024, showcasing the effectiveness of the diversification strategy [3][5]. Balance Sheet Overview - As of March 31, 2025, cash, cash equivalents, and restricted cash totaled $11.5 million, slightly up from $11.3 million at December 31, 2024 [10]. - Shareholders' equity (excluding non-controlling interests) was $24.6 million, or $3.82 per outstanding share, down from $25.2 million, or $3.92 per share at the end of 2024 [10][18].

Core Viewpoint - American Shared Hospital Services reported a 17% year-over-year revenue growth for Q1 2025, driven by strategic expansions and operational strengths despite some declines in treatment volumes [4][6]. Financial Performance - Revenue for Q1 2025 was $6.1 million, up from $5.2 million in Q1 2024, primarily due to expanded radiation therapy services [4][6]. - Direct patient services revenue surged by 224% to $3.1 million, attributed to the acquisition of Rhode Island centers and the new facility in Puebla, Mexico [4][6]. - Revenue from the medical equipment leasing segment decreased to $3.0 million from $4.3 million, influenced by lower Gamma Knife volumes and contract expirations [5][6]. Operational Highlights - The company experienced a gross margin of $942,000 in Q1 2025, down from $2.1 million in Q1 2024, mainly due to lower treatment volumes [7]. - A net loss of $625,000 was reported for Q1 2025, compared to a net income of $119,000 in the same period last year [7][16]. - Adjusted EBITDA for Q1 2025 was $0.9 million, a decrease from $1.7 million in Q1 2024 [8][18]. Strategic Initiatives - The company is optimistic about future growth, with plans for further acquisitions and operational efficiencies to enhance profitability [3][6]. - New facilities in Rhode Island and Mexico are expected to contribute to long-term growth, with a focus on expanding direct patient care services [3][4]. Balance Sheet Overview - As of March 31, 2025, cash and cash equivalents totaled $11.5 million, slightly up from $11.3 million at the end of 2024 [9][17]. - Shareholders' equity was reported at $24.6 million, down from $25.2 million at the end of the previous year [9][17].

Core Viewpoint - American Shared Hospital Services (AMS) is set to discuss its first quarter 2025 financial results in a conference call scheduled for May 15, 2025, at 12:00 pm ET [1]. Financial Results Announcement - The financial results press release for the first quarter of 2025 will be issued before the market opens on May 15, 2025 [2]. Teleconference and Webcast Information - Domestic callers can join the call by dialing 1-844-413-3972, while international callers can dial 1-412-317-5776, at least 10 minutes prior to the start [3] - A simultaneous webcast will be available on the company's website [3] - A replay of the call will be accessible until May 22, 2025, through specified phone numbers and the company's website [3] Company Overview - AMS is a leading provider of turnkey solutions for cancer treatment centers, health systems, and cancer networks in North and South America [4] - The company collaborates with partners to enhance cancer service lines and provide integrated care close to patients' homes [4] - AMS shares capital investment costs and profitability with health system partners based on ownership interests [4]