Revenue and Financial Performance - The Company recognized leasing revenue of approximately $3,137,000 and $9,699,000 for the three and nine-month periods ended September 30, 2025, compared to $3,312,000 and $11,464,000 for the same periods in the prior year[99]. - Direct patient services revenues for the three and nine-month periods ended September 30, 2025, were approximately $4,034,000 and $10,655,000, compared to $3,687,000 and $7,807,000 for the same periods in the prior year[102]. - Revenues for Q3 2025 increased by $172,000 to $7,171,000 compared to $6,999,000 in Q3 2024, and for the nine-month period, revenues increased by $1,083,000 to $20,354,000 compared to $19,271,000 in the prior year[111]. - Direct patient services revenue increased by $347,000 to $4,034,000 for Q3 2025, and by $2,848,000 to $10,655,000 for the nine-month period, driven by the RI Companies acquisition and the Puebla facility[111]. - Radiation therapy revenues from the RI Companies and Puebla facility totaled $2,918,000 for Q3 2025 and $7,832,000 for the nine-month period, compared to $2,862,000 and $4,754,000 in the prior year[112]. - PBRT system revenues decreased by $189,000 to $2,127,000 for Q3 2025 and by $1,695,000 to $5,691,000 for the nine-month period, attributed to lower volumes[113]. - Gamma Knife revenue increased by $305,000 to $2,126,000 for Q3 2025 but decreased by $300,000 to $6,831,000 for the nine-month period, reflecting mixed performance across segments[115]. Costs and Expenses - Total costs of revenue decreased by $44,000 to $5,585,000 for Q3 2025 but increased by $2,906,000 to $16,196,000 for the nine-month period[117]. - Selling and administrative expenses decreased by $385,000 to $1,538,000 for Q3 2025 and by $606,000 to $5,092,000 for the nine-month period, primarily due to lower legal costs[121]. - Interest expense increased by $56,000 to $392,000 for Q3 2025 and by $183,000 to $1,253,000 for the nine-month period, driven by increased borrowings[123]. Assets and Liabilities - Accounts receivable balances under ASC 606 at September 30, 2025, were $7,981,000, compared to $5,357,000 at September 30, 2024[102]. - The company had cash and cash equivalents of $5,345,000 as of September 30, 2025, down from $11,275,000 at December 31, 2024, reflecting a decrease of $5,930,000 during the first nine months of 2025[129]. - Working capital decreased by $12,433,000 to $3,420,000 as of September 30, 2025, compared to $15,853,000 at December 31, 2024[130]. - Long-term debt was $16,933,000 as of September 30, 2025, down from $18,462,000 at December 31, 2024[135]. - The DFC Loan has an outstanding amount of $1,313,000 as of September 30, 2025, down from $1,806,000 at December 31, 2024[138]. Financing and Commitments - The Company has secured a total of $22,000,000 in credit facilities with Fifth Third Bank, which includes a $9,500,000 term loan and a $7,000,000 revolving line of credit[132]. - The Company received a limited waiver from Fifth Third regarding its failure to comply with the maximum funded debt to EBITDA ratio covenant as of June 30, 2025[137]. - The Company anticipates being able to secure financing for future projects, although there is no assurance that financing will be available on acceptable terms[130]. - Total commitments for purchasing and installing two Leksell Gamma Knife Esprit Systems and two Linear Accelerator systems amounted to $7,884,000 as of September 30, 2025[144]. - The Company has commitments to service and maintain its Gamma Knife, LINAC, and PBRT equipment totaling $6,870,000 as of September 30, 2025[146]. Related Party Transactions - Related party transactions totaled $1,521,000 for the three months ended September 30, 2025, compared to $694,000 for the same period in 2024[148]. Operational Overview - The Company acquired 60% of the equity interests of the RI Companies, which operate three radiation therapy facilities in Rhode Island, on May 7, 2024[93]. - The Company operates seven Gamma Knife systems and one PBRT system as of September 30, 2025, under leasing contracts with hospitals[92]. - The Company has stand-alone facilities in Lima, Peru, Guayaquil, Ecuador, and Puebla, Mexico, providing direct patient services[100]. - The Company’s PBRT system at Orlando Health operates under a revenue share contract within the leasing segment[98]. - The Company’s revenue sharing arrangements include a cost-sharing component, with operating costs recorded as other direct operating costs[99]. Reimbursement Rates - The Centers for Medicare and Medicaid established a 2025 reimbursement rate of approximately $7,645 for a Medicare Gamma Knife treatment, up from $7,420 in 2024[95]. - The approximate CMS reimbursement rates for PBRT treatments in 2025 are $578 for simple treatments and $1,276 for intermediate and complex treatments[95].

Financial Data and Key Metrics Changes - Total revenue for Q3 2025 increased by 2.5% to $7.2 million compared to $7 million in Q3 2024 [16] - Year-to-date revenues increased by 5.6% to $20.4 million compared to $19.3 million in the first nine months of 2024 [18] - Adjusted EBITDA for Q3 2025 was $1.9 million, a 42% increase from $1.3 million in Q3 2024 [9][18] - Gross margins improved to 22.1% in Q3 2025, with a 60% year-over-year increase to $1.6 million [18] Business Line Data and Key Metrics Changes - Revenue from direct patient services increased by 9.4% to $4 million in Q3 2025, driven by increased procedures at the new facility in Puebla, Mexico [16] - Gamma Knife revenue increased by 16% year-over-year to $2.1 million in Q3 2025, with the number of procedures rising to 231 from 218 in Q3 2024 [17] - Revenue from the medical equipment leasing segment decreased to $3.1 million from $3.3 million in Q3 2024 due to lower proton beam radiation therapy volumes [16] Market Data and Key Metrics Changes - The new radiation therapy treatment center in Puebla, Mexico showed a remarkable 263% annual revenue growth [8] - The company expects continued growth in treatment volumes, particularly in Rhode Island, as new radiation oncologists engage with the healthcare community [10] Company Strategy and Development Direction - The company is transitioning from a medical equipment leasing focus to a more patient-centric service model, which is expected to enhance long-term shareholder value [4][5] - The acquisition of three Rhode Island cancer treatment centers and the new center in Puebla, Mexico are seen as significant growth opportunities [10] - Plans to construct a fourth radiation therapy center in Bristol, Rhode Island, and the first proton beam radiation therapy center in the state are underway, representing major growth opportunities [13] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's long-term growth strategy and the ability to weather short-term fluctuations [13] - The management team is focused on operational efficiencies and building momentum as growth strategies take hold [35] Other Important Information - The company entered Q3 2025 with cash and cash equivalents of $5.1 million, down from $11 million at the end of 2024, reflecting capital expenditures for expansion [22] - Shareholders' equity was $24.6 million, or $3.78 per outstanding share, compared to $25.2 million, or $3.92 per share at the end of 2024 [23] Q&A Session Summary Question: Concerns about shareholder value and investor outreach - A shareholder expressed concerns about the company's market cap relative to its EBITDA and suggested increased investor outreach [26] - Management acknowledged the need for more outreach and recognized the importance of communicating the company's progress to shareholders [28] Question: Disconnect between market valuation and company performance - Another investor questioned why the stock is trading at a 52-week low despite positive results and growth prospects [30] - Management attributed this to thin trading and lack of exposure, agreeing that increased outreach is necessary [32]

Revenue Growth - Q3 2025 revenue increased 2.5% to $7.2 million compared to $7.0 million in Q3 2024[6] - Direct patient care services revenue for Q3 2025 increased 9.4% to $4.0 million, representing 56% of total sales[7] - Revenue for the first nine months of 2025 increased 5.6% to $20.4 million compared to $19.3 million in the same period of 2024[11] - Direct patient care services revenue for the first nine months of 2025 increased 36.5% to $10.7 million[12] Profitability and Loss - Q3 2025 EBITDA increased 42.3% to $1.94 million compared to $1.37 million in Q3 2024[4] - Net loss for Q3 2025 decreased 91.8% to $17,000 from a loss of $207,000 in Q3 2024[9] - Net loss attributable to American Shared Hospital Services for the three months ended September 30, 2025, was $(17,000) compared to $(207,000) for the same period in 2024[30] - Total net income for the nine months ended September 30, 2025, was $(922,000), compared to $3,514,000 in 2024[30] Expenses - Interest expense for the nine months ended September 30, 2025, was $1,253,000, up from $1,070,000 in 2024[30] - Depreciation and amortization expense for the nine months ended September 30, 2025, was $4,411,000, slightly down from $4,501,000 in 2024[30] - Stock-based compensation expense for the three months ended September 30, 2025, was $101,000, compared to $88,000 in 2024[30] Cash and Assets - Cash and cash equivalents decreased to $5.3 million as of September 30, 2025, from $11.3 million at December 31, 2024[17] - Loss on write down of impaired assets and associated removal costs was $0 for the three months ended September 30, 2025, compared to $188,000 in 2024[30] - Bargain purchase gain, net, was $0 for the three months ended September 30, 2025, compared to $(263,000) in 2024[30] Tax and Interest Income - Income tax benefit for the three months ended September 30, 2025, was $48,000, compared to a benefit of $(169,000) in 2024[30] - Interest income for the nine months ended September 30, 2025, was $(157,000), down from $(252,000) in 2024[30] Business Developments - The company signed a 10-year extension with an existing health system for the latest model Gamma Knife System[3] - The new radiation therapy center in Puebla, Mexico has shown significant revenue growth since its opening[3]

Core Insights - American Shared Hospital Services reported a 2.5% increase in revenue for Q3 2025, with a significant 42.3% growth in EBITDA, indicating strong operational performance and efficiency improvements [2][5][10] - The company signed a 10-year extension with an existing health system for the latest model Gamma Knife System, which is expected to drive future revenue growth [3][4] Financial Performance - Q3 2025 revenue reached $7.2 million, up from $7.0 million in Q3 2024, primarily driven by the direct patient care services segment [7][8] - Direct patient care services revenue increased by 9.4% to $4.0 million, representing 56% of total sales, compared to 53% in the prior year [8][9] - Gross margin improved to 22.1%, up 15.8% from the previous year, reflecting higher treatment volumes [9] - Net loss decreased by 91.8% to $17,000 in Q3 2025 from a loss of $207,000 in Q3 2024 [10] Year-to-Date Results - For the first nine months of 2025, revenue increased by 5.6% to $20.4 million compared to $19.3 million in the same period of 2024 [11] - Direct patient care services revenue surged by 36.5% to $10.7 million, driven by new centers in Rhode Island and Puebla, Mexico [12] - Revenue from the equipment leasing segment decreased to $9.7 million, down from $11.5 million, due to lower Gamma Knife volumes [13] Operational Highlights - The company is expanding its footprint in Rhode Island with new radiation therapy centers, which are expected to enhance growth potential [4][6] - Capital expenditures of $7.5 million were made during the nine-month period, contributing to the decrease in cash reserves [17] Balance Sheet Overview - As of September 30, 2025, cash and cash equivalents totaled $5.3 million, down from $11.3 million at the end of 2024 [17] - Shareholders' equity was reported at $24.6 million, or $3.77 per outstanding share, compared to $25.2 million or $3.92 per share at the end of 2024 [17]

Core Points - American Shared Hospital Services (AMS) will hold a conference call on November 13, 2025, at 1:00 PM ET to discuss its third quarter 2025 financial results [2] - The financial results press release will be issued before the market opens on the same day [3] Teleconference and Webcast Information - Domestic callers can dial 1-844-413-3972 and international callers can dial 1-412-317-5776 to join the call [4] - A simultaneous webcast will be available on the company's website [4] - A replay of the call will be accessible until November 20, 2025 [4] Company Overview - AMS is a leading provider of turnkey solutions for cancer treatment centers in North and South America [5] - The company collaborates with health systems to develop cancer service lines and provide integrated care [5] - AMS shares capital investment costs and profitability with its health system partners based on ownership interests [5]

Market Overview - The market showed resilience, with the S&P 500 and NASDAQ both up by 0.5% on the day, and the Dow Jones Industrial Average gaining over 200 points [7] - Despite concerns regarding regional banks and credit, there is optimism about easing US-China trade tensions, which may have contributed to the market's positive performance [3][5] Sector Performance - Technology, consumer staples, financials, energy, and communication services were among the best-performing sectors, indicating a revival in risk appetite [9] - The Russell 2000 index, which tracks small-cap stocks, lagged behind, down approximately 0.6%, reflecting ongoing concerns in the small and mid-cap financial space [8] Individual Stock Movements - Zions Bancorp rebounded by nearly 6% after a significant decline, supported by solid earnings from regional lenders, alleviating credit quality concerns [10] - American Express saw a gain of over 7% following earnings that exceeded expectations, attributed to a refresh of its platinum credit card [12] - Oracle's stock fell nearly 7% after it suggested a smaller boost from infrastructure spending, impacting investor sentiment [18] Economic Indicators - Delinquencies on car loans have increased by 51.5% from Q1 2010 to Q1 2025, driven by rising interest rates and the cost of new cars, which have increased by over 25% since 2019 [25][26] - Treasury yields rose by 3 to 4 basis points on the shorter end of the curve, indicating a shift in investor sentiment [22]

Macro Economic Overview - The US economy shows resilience with growth driven by high-end consumer spending and significant capital expenditures in artificial intelligence [2] - Labor markets are softening, indicating potential for interest rate cuts in the near term [2] Artificial Intelligence Sector - Announced AI ecosystem deals have accelerated, with some viewed as "money good" while others may require significant equity issuances [3] - Concerns exist regarding a potential bubble in AI-related expenditures, drawing parallels to past fiber optic investments [3][4] - Companies in sectors supporting AI, such as quantum computing, are trading at elevated multiples despite limited revenue [4] Capital Markets and Investment Trends - Capital markets are open, benefiting small-cap stocks, while investment banking activity is viewed positively by bank executives [5] - Unusual trading activity around major events is noted as a negative market development [5] Consumer Behavior - High-income households are driving nearly all discretionary spending growth, although signs of a decline are emerging [6] - The housing market remains sluggish with high mortgage rates, but a recent dip may spur increased activity [6] Stock Market Dynamics - There is a notable disconnect between narrative-driven price action and intrinsic value in several market sectors [7] - Companies generating significant cash flow are struggling to attract investment, highlighting a challenging market environment [7] Ethical Investment Strategies - The Ethical S&P 500 Strategy has performed well, up 21.48% year-to-date compared to 24.63% for the S&P 500 [8] - The strategy excludes defense companies, appealing to investors seeking ethical investment options [9] Small & Micro Cap Strategy - The Small Cap Absolute Growth Strategy has exceeded expectations in its first year, focusing on small and micro-cap stocks with growth potential [11] - Notable gains include Rapid Micro Biosystems, Inc, which is up nearly 300% year-to-date [12] Company-Specific Insights - Tile Shop Holdings proposed a delisting at a price below intrinsic value, indicating a need for more home building activity to realize asset value [13] - Portillo's is undergoing leadership changes aimed at improving execution of its strategic vision [16]

Core Viewpoint - The article emphasizes the importance of sensor technology in smartphones, particularly focusing on ambient light sensors (ALS) and their role in enhancing display quality and color accuracy in various lighting conditions [1][2][3]. Group 1: Sensor Technology in Smartphones - Over the past decade, smartphone upgrades have included not only processor performance and screen resolution but also advancements in sensor technology, particularly image sensors and various other sensors like gyroscopes and ambient light sensors [1]. - The integration of an ambient light sensor is crucial for achieving precise display adjustments based on environmental lighting, which significantly influences consumer preferences for display quality [2][3]. Group 2: Challenges in Sensor Implementation - Traditional ambient light sensors face significant challenges in smartphones due to limitations in sensor placement, screen technology differences, and varying optimization strategies among manufacturers [3][4]. - The transition from LTPS to LTPO and COE technologies has reduced screen light transmittance from 3% to less than 1%, complicating the ability of ambient light sensors to accurately capture environmental light [3][4]. Group 3: Innovations by ams OSRAM - ams OSRAM has developed a series of OLED under-screen spectral color sensors to address the limitations of traditional ambient light sensors, enhancing measurement accuracy and consistency [4][6]. - The new generation of OLED under-screen spectral color sensors utilizes a unique five-channel spectral response and signal processing technology to improve environmental light reconstruction capabilities, even in complex lighting conditions [6][8]. - The introduction of a new hybrid silver filter significantly enhances the sensor's ability to block infrared light, reducing unnecessary infrared light response by up to 1000 times compared to earlier models [6][8]. Group 4: Calibration and Optimization - ams OSRAM calibrates each OLED under-screen ambient light sensor to ensure high consistency in color measurement performance across devices, compensating for individual device variations [8][9]. - The company employs specialized algorithms to mitigate the effects of backscatter light interference, ensuring accurate environmental light measurements [9][11]. Group 5: Future Outlook - ams OSRAM aims to maintain its leadership in high-precision ambient light sensing by continuing to innovate and collaborate with industry partners to achieve goals of accurate color reproduction and user comfort [11].

Core Insights - Premarket trading is showing notable activity with significant price movements indicating potential opportunities for traders [1] Premarket Gainers - PepGen Inc. (PEPG) is up 151% at $6.68 [3] - 22nd Century Group, Inc. (XXII) is up 27% at $1.93 [3] - Immuneering Corporation (IMRX) is up 23% at $11.36 [3] - uniQure N.V. (QURE) is up 10% at $52.58 [3] - Lithium Americas Corp. (LAC) is up 9% at $6.60 [3] - Jasper Therapeutics, Inc. (JSPR) is up 9% at $2.55 [3] - American Shared Hospital Services (AMS) is up 8% at $2.75 [3] - PSQ Holdings, Inc. (PSQH) is up 7% at $3.06 [3] - K Wave Media Ltd. (KWM) is up 7% at $2.48 [3] - ClearPoint Neuro, Inc. (CLPT) is up 5% at $20.48 [3] Premarket Losers - Transocean Ltd. (RIG) is down 14% at $3.11 [4] - Cyclerion Therapeutics, Inc. (CYCN) is down 12% at $2.83 [4] - CarMax, Inc. (KMX) is down 11% at $50.38 [4] - ARB IOT Group Limited (ARBB) is down 11% at $10.45 [4] - SHF Holdings, Inc. (SHFS) is down 10% at $6.49 [4] - Digital Brands Group, Inc. (DBGI) is down 10% at $6.21 [4] - Aqua Metals, Inc. (AQMS) is down 9% at $5.29 [4] - Akanda Corp. (AKAN) is down 8% at $3.96 [4] - Galecto, Inc. (GLTO) is down 8% at $3.88 [4] - Platinum Analytics Cayman Limited (PLTS) is down 7% at $11.12 [4]

[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)