Core Viewpoint - The Brink's Company (BCO) is expected to experience growth accelerating to high-single-digit percentages, supported by solid adoption trends in the industry [1]. Group 1: Investment Approach - The investment strategy focuses on long-term investments while also incorporating short-term shorts to identify alpha opportunities [1]. - The analysis is based on a bottom-up approach, examining the fundamental strengths and weaknesses of individual companies [1]. - The investment duration is medium to long-term, aiming to identify companies with solid fundamentals, sustainable competitive advantages, and growth potential [1].

Core Viewpoint - American Shared Hospital Services (AMS) has received a Certificate of Need (CON) to establish a Proton Beam Radiation Treatment (PBRT) facility in Johnston, Rhode Island, enhancing local cancer care capabilities and reducing the need for patients to travel to other states for treatment [1][2][3]. Company Developments - AMS's subsidiary, ASHS - Rhode Island Proton Beam Radiation Therapy, LLC, will construct and operate the PBRT system, expected to treat its first patients within 36 to 39 months [3]. - The new facility will complement AMS's existing three photon radiation therapy facilities in Rhode Island, where AMS holds a 60% majority ownership [4]. - In April 2024, AMS's subsidiary received another CON for Bristol Radiation Therapy, LLC, further expanding its network of radiation therapy facilities in the region [4]. Market Position and Growth Potential - The establishment of the PBRT facility represents a significant growth opportunity for AMS, as there are currently only two operational Proton Beam Radiation Therapy Systems in the Northeast [5]. - The facility's strategic location between New York City and Boston is expected to improve access to advanced cancer treatment technologies for patients in the Northeast [5]. - AMS has recently strengthened its senior management team with experienced executives to support the development and operation of radiation therapy facilities [5]. Company Background - AMS has been operational for 40 years and has been publicly traded since 1984, providing financial and technological solutions to cancer treatment centers and hospitals globally [5]. - The company collaborates with major global Original Equipment Manufacturers (OEMs) to offer a range of radiation therapy technologies, including Proton Beam Radiation Therapy Systems and Gamma Knife products [5]. - AMS's strategic initiative to acquire majority equity interests in Rhode Island radiation therapy facilities marks a shift from being a technology supplier to a direct provider of cancer care [5].

Revenue and Growth - The Company recognized leasing revenue of approximately $3,312,000 and $11,464,000 for the three and nine-month periods ended September 30, 2024, compared to $3,946,000 and $12,987,000 for the same periods in the prior year, respectively [90]. - Retail revenues for the three and nine-month periods ended September 30, 2024 were approximately $3,687,000 and $7,807,000, compared to $988,000 and $2,440,000 for the same periods in the prior year [93]. - Revenues for the three and nine-month periods ended September 30, 2024 increased by $1,865,000 (36.4%) and $3,644,000 (23.3%) to $6,999,000 and $19,271,000, respectively, compared to the same periods in the prior year [99]. - Retail segment revenues increased by $2,699,000 (273.5%) and $5,367,000 (220.5%) to $3,687,000 and $7,807,000 for the three and nine-month periods ended September 30, 2024, primarily due to the RI Acquisition [99]. - Revenues from the PBRT system increased by $97,000 (4.4%) and $308,000 (4.4%) to $2,316,000 and $7,386,000 for the three and nine-month periods ended September 30, 2024, driven by higher volumes and a shift in payor mix [100]. - Gamma Knife revenue decreased by $895,000 (32.9%) and $1,218,000 (14.6%) to $1,821,000 and $7,131,000 for the three and nine-month periods ended September 30, 2024, due to lower procedure volumes [102]. Acquisitions and Investments - 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 [83]. - The Company recorded a net bargain purchase gain of $3,942,000 related to the RI Acquisition, which closed on May 7, 2024, after acquiring 60% of the equity interests of the RI Companies for $2,850,000 [114]. - As of September 30, 2024, the Company had commitments totaling $13,383,000 for the purchase and installation of four Leksell Gamma Knife Esprit Systems and two Linear Accelerator systems [128]. - The Supplemental Term Loan of $2,700,000 was added to the credit agreement to finance capital expenditures in Puebla, Mexico [122]. Financial Performance and Expenses - Total costs of revenue increased by $2,597,000 (85.6%) and $4,191,000 (46.0%) to $5,629,000 and $13,290,000 for the three and nine-month periods ended September 30, 2024 [106]. - Selling and administrative expenses increased by $188,000 (10.8%) and $436,000 (8.3%) to $1,923,000 and $5,698,000 for the three and nine-month periods ended September 30, 2024, due to higher personnel costs and legal fees [111]. - Interest expense increased by $59,000 (21.3%) and $245,000 (29.7%) to $336,000 and $1,070,000 for the three and nine-month periods ended September 30, 2024, attributed to higher borrowings and interest rates [113]. Cash and Debt Management - The Company had cash, cash equivalents, and restricted cash of $14,077,000 as of September 30, 2024, an increase of $269,000 from December 31, 2023 [119]. - Working capital decreased by $1,518,000 (15.6%) to $8,159,000 as of September 30, 2024, primarily due to increases in accounts payable and accrued liabilities [120]. - The Company has a combined long-term debt of $14,375,000 as of September 30, 2024 [126]. - The Company entered into a $22,000,000 credit agreement with Fifth Third Bank, which includes a $9,500,000 term loan, a $5,500,000 delayed draw term loan, and a $7,000,000 revolving line of credit [121]. - The Company borrowed $4,500,000 under the revolving line of credit as of September 30, 2024 [128]. - The Company is subject to covenants under the credit agreement, including a minimum fixed charge coverage ratio of 1.25 to 1.0 and a total funded debt to EBITDA ratio of 3.0 to 1.0 [123]. - The Company is in compliance with all debt covenants as of September 30, 2024 [125]. Regulatory and Market Conditions - The Centers for Medicare and Medicaid established a 2024 reimbursement rate of approximately $7,420 for a Medicare Gamma Knife treatment, down from $7,691 in 2023 [85]. - The approximate CMS reimbursement rates for PBRT treatments in 2024 are $561 for simple treatments and $1,362 for intermediate and complex treatments, compared to $572 and $1,323 in 2023, respectively [85]. Operational Overview - The Company operates ten domestic Gamma Knife units and one PBRT system in the United States as of September 30, 2024 [89]. - The Company has two international Gamma Knife units in operation in Lima, Peru, and Guayaquil, Ecuador, as part of its retail segment [89]. - The Company’s leasing contracts typically have a ten-year term and are classified as either fee per use or revenue sharing [90]. - The Company’s PBRT system at Orlando Health operates under a revenue share contract within the leasing segment [89]. Related Party Transactions - Total related party transactions for the three months ended September 30, 2024, amounted to $694,000, compared to $2,338,000 for the same period in 2023 [132]. - The Company has cash on hand of $14,077,000 as of September 30, 2024, and is actively seeking financing resources for future projects [128].

Financial Data and Key Metrics Changes - Revenue for Q3 2024 increased by 36% year-over-year to $6.99 million, up from $5.1 million in Q3 2023, driven by the Rhode Island acquisition and the new facility in Puebla, Mexico [14][31] - Gross margin decreased to $1.37 million from $2.10 million in Q3 2023, impacted by lower Gamma Knife treatment volumes and a shift in revenue mix [15][35] - The company reported a net loss of $207,000 or $0.03 per share for Q3 2024, compared to a net income of $118,000 or $0.02 per share in Q3 2023 [15][39] - Cash and equivalents at the end of Q3 2024 stood at over $14.1 million, approximately $2.17 per share [16][43] Business Line Data and Key Metrics Changes - Revenue from the Patient Services or Retail segment surged by 273% to $3.7 million in Q3 2024, primarily due to the Rhode Island acquisition and Puebla operations [32] - Medical Equipment Leasing revenue decreased by 16.1% to $3.31 million, attributed to lower Gamma Knife volumes [33] - Proton therapy revenue increased by 4.4% to $2.3 million, with a 5.4% rise in proton therapy fractions [34] Market Data and Key Metrics Changes - The international business is seen as a significant growth opportunity, with the only Gamma Knife systems in Peru and Ecuador, and a new center in Puebla, Mexico [24] - A joint venture for a Gamma Knife facility in Guadalajara, Mexico was announced, which will be one of only three in the country [25] Company Strategy and Development Direction - The company is focused on integrating the Rhode Island acquisition and optimizing operations, which includes investing in upgraded equipment and improving operational efficiencies [13][19] - Plans to expand geographically and diversify product offerings, including the addition of linear accelerators and a proton beam center in Rhode Island [69][70] Management's Comments on Operating Environment and Future Outlook - Management acknowledged challenges such as seasonality, procedure volume fluctuations, and integration costs from the Rhode Island acquisition [13][26] - There is optimism about future growth, particularly from international operations and new business opportunities [29][73] Other Important Information - The company has incurred additional costs related to the Rhode Island acquisition, expected to decrease in Q4 2024 [26] - The bargain purchase gain from the Rhode Island acquisition was increased by $263,000 in Q3 2024 [38] Q&A Session Summary Question: Follow-up on start-up costs and ramp-up period for new centers - Management confirmed that costs related to the Rhode Island acquisition and integration are impacting results, and acknowledged a ramp-up period for new centers [46][47] Question: Performance of the Puebla facility - Management expressed satisfaction with the revenue growth from the Puebla facility since its opening [51] Question: Impact of outdated equipment on business - Management noted that replacing outdated equipment has led to increased patient referrals and volumes [55][56] Question: Marketing efforts for the Rhode Island centers - Management confirmed ongoing marketing efforts to raise awareness among referring physicians about the upgraded facilities [58][60] Question: Gamma Knife treatment volume issues - Management attributed the decline in Gamma Knife volumes to various factors, including physician vacations and equipment downtime, but expressed confidence in overcoming these challenges [61][62] Question: Concerns about stock performance and transparency - Management acknowledged shareholder frustrations and emphasized the long-term growth strategy, including geographic expansion and product diversification [68][70]

Revenue Performance - Total revenue for Q3 2024 was $6,999,000, representing a 36.3% increase compared to Q3 2023[2] - Revenue from direct patient services ("retail") segment reached $3,687,000, a significant increase of 273.2% year-over-year[3] - Revenue from medical equipment leasing segment was $3,312,000, reflecting a decrease of 16.1% compared to the prior year[4] - Proton beam radiation therapy revenue increased by 4.4% to $2,316,000, with treatments rising by 5.4%[11] - Gamma Knife revenue decreased by 32.9% to $1,821,000, with procedures down by 31.0%[12] - For the first nine months of 2024, total revenue increased by 23.3% to $19,271,000 compared to $15,627,000 in the same period of 2023[17] - Revenues for the three months ended September 30, 2024, were $6,999,000, a 36.4% increase from $5,134,000 for the same period in 2023[29] Profitability and Loss - Gross margin decreased to $1,370,000, with a gross margin percentage of 19.6%, down from 40.9% in the previous year[5] - Net loss for Q3 2024 was $207,000, or ($0.03) per diluted share, compared to net income of $118,000, or $0.02 per diluted share in Q3 2023[6] - Adjusted EBITDA for Q3 2024 was $1,366,000, down from $1,669,000 in Q3 2023[6] - Gross margin decreased to $1,370,000 for the three months ended September 30, 2024, compared to $2,102,000 in the prior year, reflecting a decline of 34.8%[29] - Adjusted EBITDA for the three months ended September 30, 2024, was $1,366,000, down 18.1% from $1,669,000 in the same period of 2023[30] - Net loss attributable to American Shared Hospital Services was $207,000 for the three months ended September 30, 2024, compared to a net income of $118,000 in the prior year[29] Financial Position - Cash at September 30, 2024, was $14,077,000, compared to $13,808,000 at December 31, 2023[21] - Total assets increased to $63,269,000 as of September 30, 2024, up from $48,162,000 at the end of 2023, representing a growth of 31.4%[29] - Current liabilities rose to $17,561,000 as of September 30, 2024, compared to $10,779,000 at the end of 2023, indicating a 62.5% increase[29] - Cash and cash equivalents increased to $14,077,000 as of September 30, 2024, compared to $13,808,000 at the end of 2023, a growth of 1.9%[29] Expenses - Selling and administrative expenses were $1,923,000 for the three months ended September 30, 2024, compared to $1,735,000 in the same period of 2023, an increase of 10.8%[29] - Interest expense for the three months ended September 30, 2024, was $336,000, up from $277,000 in the prior year, reflecting a rise of 21.3%[29] Other Financial Metrics - The company reported a bargain purchase gain of $263,000 for the three months ended September 30, 2024, compared to a gain of $0 in the same period of 2023[29]

Core Insights - American Shared Hospital Services reported a revenue increase of 36.3% year-over-year for Q3 2024, reaching $6,999,000, driven by the acquisition of Rhode Island radiation therapy facilities and a new facility in Puebla, Mexico [2][4][6] Financial Performance - Total revenue for Q3 2024 was $6,999,000, up from $5,134,000 in Q3 2023 [6] - Revenue from direct patient services ("retail") surged 273.2% to $3,687,000, primarily due to the new Rhode Island and Puebla facilities [2][7] - Medical equipment leasing revenue decreased by 16.1% to $3,312,000, attributed to lower Gamma Knife treatment volumes [2][8] - Proton beam radiation therapy revenue increased by 4.4% to $2,316,000, with treatment volumes rising by 5.4% [9] - Gamma Knife operations revenue fell by 32.9% to $1,821,000, with procedures down 31.0% due to contract expirations and equipment downtime [10] - Gross margin decreased to $1,370,000, representing 19.6% of revenue, down from 40.9% in the previous year [2][4] - Operating income turned to a loss of $889,000 compared to an income of $90,000 in Q3 2023, mainly due to increased operating costs [12] - Net loss for Q3 2024 was $207,000, or ($0.03) per diluted share, compared to a net income of $118,000, or $0.02 per diluted share, in Q3 2023 [14] - Adjusted EBITDA for Q3 2024 was $1,366,000, down from $1,669,000 in Q3 2023 [15] Balance Sheet Highlights - Cash and cash equivalents as of September 30, 2024, were $14,077,000, an increase from $13,808,000 at the end of 2023 [3][21] - Shareholders' equity increased to $26,423,000 as of September 30, 2024, compared to $22,624,000 at the end of 2023 [21] Strategic Outlook - The company is focused on long-term growth strategies, including improving operational efficiencies and expanding its product portfolio [4][5] - The CEO expressed confidence in the company's growth trajectory, supported by a strong balance sheet and increasing sales pipeline [5]

Core Points - American Shared Hospital Services (AMS) will hold a conference call to discuss its third quarter 2024 financial results on November 13, 2024, at 1:00 PM ET [1] - The financial results press release will be issued before the market opens on the same day [1] Company Overview - AMS is a leading provider of turnkey technology solutions for stereotactic radiosurgery and advanced radiation therapy equipment and services [1] - The company collaborates with major global Original Equipment Manufacturers (OEMs) to provide clinical treatment systems and software for cancer treatment [4] - AMS offers a range of products including MR Guided Radiation Therapy Linacs, Advanced Digital Linear Accelerators, Proton Beam Radiation Therapy Systems, and Brachytherapy systems [4]

Core Insights - American Shared Hospital Services (AMS) has appointed Gary Delanois as Chief Operating Officer, bringing extensive experience in radiation oncology services management [1][2] - Ranjit Pradhan has been promoted to Senior Vice President of Sales and Marketing, having successfully renewed and expanded five Gamma Knife agreements in the past 18 months [1][2] Company Leadership Changes - Gary Delanois has 28 years of healthcare management experience, with a strong track record in operating performance and relationship building with physicians and partners [2][3] - Prior to joining AMS, Delanois served as CFO for a major primary care provider and held senior operational roles at 21st Century Oncology [3][4] - Ranjit Pradhan will lead strategic marketing initiatives and drive growth in new business, leveraging his extensive experience in global healthcare markets [5] Company Overview - AMS is a leading provider of technology solutions for cancer treatment, working with major global Original Equipment Manufacturers (OEMs) [6][7] - The company offers a range of products including MR Guided Radiation Therapy, Advanced Digital Linear Accelerators, and Proton Beam Radiation Therapy Systems [7]

Financial Data and Key Metrics Changes - Total revenue for Q2 2024 was $7.1 million, a year-over-year increase of 27% from $5.7 million in Q2 2023 [11][14] - Net income attributable to the company was $3.6 million or $0.55 per diluted share, compared to a net loss of $111,000 or $0.02 per diluted share in Q2 2023 [17] - Adjusted EBITDA for Q2 2024 was $2 million, slightly up from $1.9 million in Q2 2023 [18] Business Line Data and Key Metrics Changes - Revenue from the leasing segment was $3.9 million, a decrease of 19% compared to $4.81 million in the prior year [14] - Revenue from the retail segment surged to $3.16 million, marking a 318% increase from $756,000 in the year-ago quarter, driven by the Rhode Island acquisition and increased volumes [14] - Proton therapy revenue decreased by 5% to $2.42 million, while total proton therapy fractions fell by 10% [15] Market Data and Key Metrics Changes - International retail results showed growth, particularly in Ecuador and Peru, with the upgrade of equipment contributing to increased volumes [9] - The Gamma Knife procedures revenue decreased by 9% to $2.74 million, but excluding expired contracts, procedures increased by 24% [15] Company Strategy and Development Direction - The company is focusing on expanding its retail segment, as evidenced by the Rhode Island acquisition and new centers in Mexico [9][23] - Plans include building a proton beam radiation therapy center in Rhode Island, which would be the only system between New York City and Boston [10] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the future, highlighting the strong performance in Q2 and the strategic acquisition in Rhode Island [7][32] - The company anticipates stronger international growth and additional revenue streams from new centers and acquisitions [12][32] Other Important Information - The company ended Q2 2024 with over $14.5 million in cash, approximately $2.24 per share [12] - Shareholders' equity increased to $26.5 million or $4.17 per share at the end of Q2 2024, up from $22.6 million or $3.59 per share at the end of 2023 [20] Q&A Session Summary Question: Confirmation on growth opportunities in direct business and potential service interruptions at Sacred Heart - Management confirmed focus on both leasing and retail segments, with a stronger emphasis on retail opportunities [23] Question: Clarification on the timing of the Rhode Island acquisition - Management confirmed that the acquisition concluded in early May, thus not reflecting a full three months in the reported quarter [25] Question: Insights from the direct relationship and updates on the proton beam project - Management noted delays in the CON application process but expressed confidence in the outcome and highlighted ongoing learning from the new operations [27][28] Question: Marketing strategies for Rhode Island centers and sales pipeline updates - Management indicated a robust sales pipeline and ongoing market engagement to identify new opportunities [30]

Financial Performance - Total revenue for Q2 2024 was $7.1 million, a 27% increase year-over-year, driven by the acquisition of Rhode Island facilities which contributed $1.9 million to the revenue growth[1][5] - Net income for Q2 2024 was $3.6 million, or $0.55 per diluted share, compared to a net loss of $111,000, or $0.02 per diluted share in Q2 2023, primarily due to a $3.7 million bargain purchase gain from the Rhode Island acquisition[2][9] - Adjusted EBITDA for Q2 2024 was $2,010,000, up from $1,938,000 in Q2 2023, reflecting contributions from the newly acquired Rhode Island facilities[3][9] - Revenues for the three months ended June 30, 2024, increased to $7,056,000, up 27% from $5,568,000 in the same period last year[21] - Net income attributable to American Shared Hospital Services for the three months ended June 30, 2024, was $3,602,000, compared to a net loss of $111,000 in the same period last year[21] - Basic earnings per share for the three months ended June 30, 2024, was $0.56, compared to a loss of $0.02 in the same period last year[21] Cash and Assets - Cash and cash equivalents at June 30, 2024, were $14.5 million, an increase from $13.8 million at December 31, 2023[3][12] - Total assets as of June 30, 2024, increased to $60,825,000, up from $48,162,000 as of December 31, 2023[22] - Cash and cash equivalents as of June 30, 2024, were $14,486,000, compared to $13,808,000 as of December 31, 2023[22] Revenue Segments - Revenue from the retail segment increased by 318% to $3,157,000 in Q2 2024, compared to $756,000 in the same period last year, attributed to the Rhode Island acquisition and increased patient volumes[5][6] - Proton beam radiation therapy revenue decreased by 5% to $2.4 million in Q2 2024, with a 10% decline in therapy fractions compared to the same period last year[6][8] Operational Metrics - Total Gamma Knife procedures increased by 10% to 340 in Q2 2024, compared to 309 in Q2 2023, despite a 9% decrease in overall Gamma Knife revenue due to contract expirations[6][7] - Gross margin for Q2 2024 was $2.5 million, or 35% of revenue, down from 45% in the prior year, reflecting the expansion in the retail segment[2][7] - Gross margin for the six months ended June 30, 2024, was $4,611,000, representing a 4% increase compared to $4,426,000 for the same period in 2023[21] Liabilities and Expenses - Current liabilities as of June 30, 2024, were $13,336,000, compared to $10,779,000 as of December 31, 2023[22] - Interest expense for the three months ended June 30, 2024, was $385,000, an increase from $277,000 in the same period last year[21] Strategic Developments - The company signed a joint venture agreement for a Gamma Knife facility in Guadalajara, Mexico, marking its fourth international center[4] - The company reported a bargain purchase gain of $3,679,000 for the three months ended June 30, 2024[21]