d8c1747ec76146e4cd48c5bb3c47c30b9bd221e197b232acb86076f9b9113445

Operating income in Q1 2023 was significantly lower, dropping to **$98,000** compared to **$600,000** in Q1 2022—a decline of about **83.7%**. This decrease was due to **higher operating costs**, an increase of **16.7%** in **selling and administrative expenses** (rising from **$1,319,000** to **$1,539,000**), and a **24.3%** increase in **interest expense** (from **$148,000** to **$184,000**), all of which negatively impacted the operating income.  **[0001437749-23-014058_ex_519131.htm:2]** **[AMS_3251277_3]** 

Why was Operating income so low in Q1 2023?

The negative operating income in Q2 2023 was primarily driven by **higher selling and administrative expenses**—which increased by **73.5%** (rising from **$1,146,000** in Q2 2022 to **$1,988,000** in Q2 2023) due to investments in new business opportunities (around **$250,000**) and increased salaries for additional management and sales staff—and by **increased reserves for impaired assets and anticipated removal costs** of **$578,000** associated with potential non-renewals of Gamma Knife agreements. These factors outweighed the benefits from a **20.6% improvement in gross margin**, resulting in a negative operating income for the period.  **[0001437749-23-023719_ex_560295.htm:0]** **[0001437749-23-023719_ex_560295.htm:2]** 

What factors led to a negative Operating income in Q2 2023?

AMS's net income turned negative in **Q2 2023** due to several compounding factors. The company incurred a **$578,000 loss from impaired assets and removal costs**, which represented a major non-recurring charge.  **[AMS_3382930_0]** **[AMS_3382930_3]** **[0001437749-23-023568_asha20230630_10q.htm:21]**  Additionally, **selling and administrative expenses surged by 73.5% to $2 million** (up from $1.1 million) as the company invested in new business opportunities and expanded its management and sales teams.  **[AMS_3382930_3]** **[AMS_3309674_4]**  The effect was compounded by **increased interest expenses** (rising from $149,000 to $167,000) due to higher rates on variable debt, and a **15.4% decline in international revenue** (down to $756,000 from $894,000).  **[AMS_3382930_3]** **[AMS_3309674_4]**  Even though an **income tax benefit of $35,000** was recorded, it was insufficient to counteract these negative impacts, leading to a net loss in Q2 2023.  **[AMS_3382930_3]** **[0001437749-23-023568_asha20230630_10q.htm:21]** 

Why did Net income turn negative in Q2 2023?

The drop in EPS for Q2 2023 was driven by several factors. **Higher selling and administrative expenses** increased by **73.5%** (from **$1.1 million** to **$2 million**), which included additional costs for new business opportunities and higher salaries. There was also a **$578,000 loss on impaired assets and removal costs** and a shift from an **operating income of $793,000** in Q2 2022 to an **operating loss of $325,000** in Q2 2023. Despite an **income tax benefit of $35,000** in Q2 2023 compared to an expense of **$248,000** in Q2 2022, these challenges led to a **net loss of $111,000** in Q2 2023, contributing to the EPS decline.  **[AMS_3382930_3]** **[AMS_3309674_4]** 

What caused the drop in EPS in Q2 2023?

2e3038f4ce27787b64e9b7b81f9f517aea7764a0695f8c662a12491aba036540

Adjustments for Non-Cash Items (USD)

Stock-Based Compensation (USD)

Changes in Working Capital (USD)

Capital Expenditures (CapEx) (USD)

Proceeds from / Repayments of Debt (USD)

Share Repurchases (USD)

Dividend Payments (USD)

Net Change in Cash (USD)

bf3a9da49fae3237ef63228ec5ba563d09fe6e4c44f3daff982156db43295757

176f08830a31fb1ca499a5222c2d46baa80d350a6f0b5aa7ad9435ddd3411498

Leasing

- Gamma Knife

- PBRT

Retail

- Other Retail Revenue

Equipment Sales

- IGRT

- Patient Income (Lima, Peru)

Radiation Therapy Revenue

Total Revenue

725ab8bb5f30edb5f8bce0fc9287c1eba2f7aff1c61ec39bd5799978cf49e06a

The documents indicate that the **restricted cash** increased by **$132,000** in Q1 2024, from **$118,000 at December 31, 2023** to **$250,000 at March 31, 2024**; however, they do not provide specific details on what drove this jump.  **[0001437749-24-017104_asha20240331_10q.htm:1]** 

What drove the jump in Restricted cash in Q1 2024?

The surge in **Accounts receivable** for Q2 2024 was primarily driven by the **acquisition of a 60% equity interest in three Rhode Island radiation therapy facilities** in May 2024, which generated additional revenue and receivables under AMS's ownership.  **[0001437749-24-026859_ex_714831.htm:0]** **[0001437749-24-026762_asha20240611_10q.htm:26]**  Additionally, there was a significant **increase in retail revenue**—rising from **$756,000 in Q2 2023 to $3,157,000 in Q2 2024**—and **higher procedure volumes at international locations** contributed further to this growth.  **[AMS_3398886_2]** **[0001437749-24-026762_asha20240611_10q.htm:26]** 

Why did Accounts receivable surge in Q2 2024?

The surge in **Total assets** in Q3 2024 was primarily driven by several factors. These include the **acquisition of a 60% equity interest in two Rhode Island entities**, which operate three radiation therapy facilities, a significant **increase in accounts receivable** (from **$4,343,000** to **$8,635,000**), an increase in **property and equipment** (from **$25,844,000** to **$34,807,000**), and a modest rise in **cash and cash equivalents** (from **$13,690,000** to **$13,827,000**).  **[0001437749-24-035251_asha20240930_10q.htm:1]** **[0001437749-24-034762_ex_745759.htm:0]** **[0001437749-24-035251_asha20240930_10q.htm:20]** 

What contributed to the surge in Total assets in Q3 2024?

The increase in the Line of credit in Q3 2024 was primarily driven by **strategic initiatives**, including leveraging the company's resources for additional long-term revenue streams and executing the **Rhode Island acquisition** along with other business opportunities.  **[0001437749-24-035251_asha20240930_10q.htm:32]** 

What led to the increase in the Line of credit in Q3 2024?

The **Total current liabilities** increased sharply in Q3 2024 primarily due to **significant increases** across several areas. Notably, there were marked rises in **Accounts Payable**, **Employee Compensation and Benefits**, **Other Accrued Liabilities**, **Related Party Liabilities**, **Line of Credit**, and the **Current Portion of Long-term Debt, Net**. These changes were largely driven by the company's **recent acquisitions and expansions**, including the **Rhode Island acquisition**, which contributed to higher operational and financial obligations.  **[0001437749-24-035251_asha20240930_10q.htm:1]** 

Why did Total current liabilities rise so sharply in Q3 2024?

2cacfb78cb844dd1459ad1d995aa18a85f3931a0e0eec3c0ffa8817604ca142d

Revenues (USD, thousands)

Costs of revenue (USD, thousands)

Gross margin (USD, thousands)

Selling and administrative expense (USD, thousands)

Interest expense (USD, thousands)

Operating income (loss) (USD, thousands)

Interest and other income (loss) (USD, thousands)

Income before income taxes (USD, thousands)

Income tax expense (benefit) (USD, thousands)

Net income (loss) (USD, thousands)

Plus (less): Net (income) loss attributable to non-controlling interests (USD, thousands)

Net income attributable to American Shared Hospital Services (USD, thousands)

Net income per common share - basic (USD)

Net income per common share - diluted (USD)

Weighted average common shares for basic earnings per share (thousands)

Weighted average common shares for diluted earnings per share (thousands)

460a4471d7165ff97c7fc2363651a367dbd5bf54ad0ea93620c4505f06a70967

Net income (USD)

Depreciation, amortization, and other (USD)

Accretion of debt issuance costs (USD)

Non cash lease expense (USD)

Stock-based compensation expense (USD)

Changes in Receivables (USD)

Changes in Prepaid expenses and other assets (USD)

Changes in Accounts payable, accrued liabilities, and deferred revenue (USD)

Changes in Income taxes payable (USD)

Changes in Lease liabilities (USD)

Net cash (used in) provided by operating activities (USD)

Payment for purchases of property and equipment (USD)

Net cash used in investing activities (USD)

Principal payments on long-term debt (USD)

Payments on line of credit (USD)

Advances on line of credit (USD)

Long-term debt financing (USD)

Capital contribution non-controlling interests (USD)

Distributions to non-controlling interests (USD)

Debt issuance costs long-term debt (USD)

Net cash provided by (used in) financing activities (USD)

Net change in cash, cash equivalents, and restricted cash (USD)

Interest paid (USD)

Income taxes paid (USD)

Deferred income taxes (USD)

Cash, cash equivalents, and restricted cash at beginning of period (USD)

Cash, cash equivalents, and restricted cash at end of period (USD)

Equipment included in accounts payable and accrued liabilities (USD)

Cash and cash equivalents (USD)

Restricted cash (USD)

653cd22747aadbc2566933bedfa3557d6880d6b3ca5702ac2db64c120531b660

Domestic (U.S.)

Foreign

- Lima, Peru

- Guayaquil, Ecuador

aa17633c8cbfc2a3e33de03f75f54b1f06c310f7d2e56e39200158b0e5bfc6eb

Total current assets (USD, thousands)

Total assets (USD, thousands)

Total current liabilities (USD, thousands)

Total equity-American Shared Hospital Services (USD, thousands)

5e7b72b5a3a839d6c84e4f293b6cad7bf405f0c8691742a3bc1f7a9b074ac9cf

American Shared Hospital Services (AMS)

Financials