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Here are 1-3 brief analogies to describe American Shared Hospital Services (AMS):

• AWS for high-tech hospital treatment equipment: AMS provides cutting-edge medical equipment (like Gamma Knife radiosurgery units) and its operational support to hospitals on a shared-service model, much like Amazon Web Services provides computing infrastructure to businesses without them needing to own their own data centers.
• ADP for specialized hospital operations: AMS allows hospitals to outsource the complex, capital-intensive operations of highly specialized procedures like Gamma Knife radiosurgery, similar to how ADP manages payroll and HR functions for many businesses.

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• Radiosurgery and Radiation Therapy Solutions: Providing hospitals and medical centers with comprehensive solutions for advanced radiosurgery and conventional radiation therapy treatments, including equipment, technical staff, and operational support.
• Proton Therapy Solutions: Offering comprehensive services for the implementation and operational management of cutting-edge proton beam radiation therapy systems for cancer treatment.

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American Shared Hospital Services (AMS) - Major Customers

American Shared Hospital Services (AMS) primarily sells its services and equipment to other companies, specifically healthcare providers and institutions. It operates on a business-to-business (B2B) model.

Based on their latest public filings, AMS's major customers are:

• San Francisco Cancer Institute (SFCI): This private entity is a primary customer for AMS's proton therapy services, specifically operating the California Advanced Proton Therapy Center (CAPTC). It accounted for approximately 73% of AMS's consolidated revenues in 2023.
• Radeas, Inc.: This private company is a major customer for AMS's Gamma Knife radiosurgery services, primarily in Florida. It accounted for approximately 25% of AMS's consolidated revenues in 2023.

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• Elekta AB (ELKTY)
• Siemens Healthineers AG (SHL.DE)
• Ion Beam Applications S.A. (IBAB.BR)

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Gary Delanois, Chief Executive Officer

Gary Delanois was appointed CEO of American Shared Hospital Services on April 3, 2025. He previously served as Executive Vice President and Chief Operating Officer, a position he assumed on October 18, 2024. With over 28 years of progressive healthcare management experience, Mr. Delanois has provided innovative solutions to Physician Groups, Health Systems, ACO's, and Health Plans. He has a strong track record of exceptional operating performance, growth, and results, and significant Board of Director experience with various healthcare systems. Prior to joining AMS, Mr. Delanois was the CFO of a large comprehensive primary care healthcare provider in Southwest Florida with over 900 providers. Before that, he spent over 15 years at 21st Century Oncology, progressing to Senior Vice President-US Operations, where he was responsible for daily operations at over 140 radiation therapy centers. He began his career as a Certified Public Accountant at Ernst & Young and later became a Senior Manager with Coopers & Lybrand.

R. Scott Frech, Chief Financial Officer

R. Scott Frech was appointed Chief Financial Officer of American Shared Hospital Services on December 19, 2024. Prior to his role at AMS, Mr. Frech served as the Chief Financial Officer of Radiation Business Solutions from October 2021 to December 2024. From February 2016 to June 2020, he held the position of Vice President and Chief Financial Officer of Population Health, where he was involved in planning and developing long-term strategies for an accountable care organization (ACO) and a clinically integrated network (CIN). He also served as Assistant Vice President, Financial Services, at Palos Community Hospital from 2008 to 2015. Mr. Frech is a Certified Public Accountant.

Raymond C. Stachowiak, Executive Chairman

Raymond C. Stachowiak has served as Executive Chairman of American Shared Hospital Services since April 2025. He previously held the role of CEO from October 2020 to March 2023, and again from April 2024 to April 2025, also serving as Interim President and CEO from May 2020. Mr. Stachowiak joined the board in 2009. He founded Shared Imaging LLC in December 1991 and served as its President and Chief Executive Officer until his retirement in March 2013. In 2008, he sold 50% of his interest in Shared Imaging to Lubar Equity Fund and retains a 50% ownership stake. Mr. Stachowiak is the sole owner of RCS Investments, Inc., and owner-manager of Stachowiak Equity Fund, both of which are private equity funds, demonstrating a pattern of managing companies backed by private equity firms.

Craig K. Tagawa, President and Chief Operating Officer

Craig K. Tagawa was appointed President and Chief Operating Officer of American Shared Hospital Services, effective April 18, 2024. He is one of the company's longest-standing employees.

Gregory A. Mercurio Jr., Senior Vice President of Radiation Oncology

Gregory A. Mercurio Jr. was appointed Senior Vice President of Radiation Oncology in April 2024. He is an experienced entrepreneurial senior management executive with over 40 years in the healthcare industry, possessing expertise in orthopedics, microsurgery, laser surgery, lithotripsy, PET/CT Imaging, and radiation oncology. Mr. Mercurio is skilled in forming strategic alliances, joint ventures, and partnerships across healthcare sectors. His background includes leading business and clinical services development within hospital systems, guiding medical product manufacturers, managing independent contractor relations, and owning and operating various healthcare businesses. He has particular expertise in obtaining Certificates of Need for establishing and operating advanced imaging and radiation therapy facilities. For 15 years, he served a nationally recognized radiation therapy provider, where he developed strategies to secure Certificates of Need for five radiation therapy facilities in Rhode Island through joint ventures with community hospitals.

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The key risks to American Shared Hospital Services (AMS) include immediate liquidity and financing concerns, consistent declines in its equipment leasing segment, and challenges associated with integrating acquisitions and expanding into new markets.

1. Lender Default and Liquidity Risk: American Shared Hospital Services faces a significant risk due to a recent Event of Default notice from Fifth Third Bank. This stems from the company's failure to maintain a minimum of $5,000,000 in unrestricted cash and cash equivalents, as required by its Credit Agreement. As a result, the bank has suspended a $7,000,000 revolving loan commitment for new advances and has reserved the right to accelerate all outstanding obligations and act against collateral. This situation poses a material threat to the company's liquidity and its ability to secure future financing.
2. Declines in Equipment Leasing Revenue and Treatment Volumes: The company has consistently reported a decrease in revenue from its equipment leasing segment, particularly impacting its Gamma Knife and proton beam therapy operations. This decline is attributed to lower treatment volumes and the expiration of customer contracts. For example, the equipment leasing segment's revenue decreased to $3.6 million in Q2 2025 from $3.9 million in Q2 2024, and total proton beam radiation therapy revenue also saw a decrease in the same period. These ongoing reductions contribute to net losses and affect the company's overall financial performance.
3. Integration and Expansion Challenges: While American Shared Hospital Services is actively pursuing growth through strategic acquisitions, such as the Rhode Island radiation therapy operations, and expanding into international markets like Mexico, these initiatives introduce inherent risks. Challenges can include integration costs, operational hurdles in new regions, and the potential for these acquisitions to negatively impact financial results if not managed effectively.

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The emergence of ultra-high dose rate radiation therapy (FLASH radiotherapy).

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American Shared Hospital Services (AMS) operates in the medical technology sector, primarily providing financing solutions and turnkey services for advanced radiosurgery and radiation therapy equipment. Their main products and services encompass Gamma Knife radiosurgery, Proton Beam Radiation Therapy (PBRT) systems, and a range of advanced radiation therapy equipment including MR Guided Radiation Therapy Linacs, Advanced Digital Linear Accelerators, and Brachytherapy systems for Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT).

Addressable Markets:

• Gamma Knife Radiosurgery Equipment and Services: The U.S. market for Gamma Knife was estimated at USD 129.6 million in 2023 and is projected to reach USD 189.5 million by 2030, demonstrating a compound annual growth rate (CAGR) of 5.6% from 2024 to 2030. Globally, the Gamma Knife market is estimated to be valued at USD 390.9 million in 2025 and is projected to reach USD 776.3 million by 2035, with a CAGR of 7.6%.
• Proton Beam Radiation Therapy (PBRT) Systems and Services: The U.S. proton therapy market was valued at USD 172.32 million in 2024 and is anticipated to reach approximately USD 612.01 million by 2034, growing at a CAGR of 13.49% from 2025 to 2034. The global proton therapy systems market was valued at USD 1.49 billion in 2024, projected to reach USD 1.66 billion in 2025 and USD 4.09 billion by 2035, at a CAGR of 9.4%.
• Advanced Radiation Therapy Equipment and Services (including MR Guided Radiation Therapy Linacs, Advanced Digital Linear Accelerators, Brachytherapy systems, IMRT/IGRT): The U.S. radiotherapy market, which encompasses these technologies, was estimated at USD 2.10 billion in 2023 and is predicted to grow to about USD 3.95 billion by 2033, with a CAGR of 6.52% from 2024 to 2033. The global radiation therapy equipment market size was valued at USD 3.6 billion in 2024 and is projected to reach USD 5.93 billion by 2032, growing at a CAGR of 7.10% from 2026 to 2032.

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Expected Drivers of Future Revenue Growth for American Shared Hospital Services (AMS)

Over the next 2-3 years, American Shared Hospital Services (AMS) is expected to drive future revenue growth through several key strategies, primarily focusing on expansion within its direct patient services segment and leveraging strategic acquisitions:

1. Acquisitions and Expansion of Direct Patient Services (Retail): A significant driver of recent and anticipated future revenue growth stems from strategic acquisitions and the establishment of new direct patient service facilities. The acquisition of a 60% equity interest in two entities operating three radiation therapy facilities in Rhode Island and the commencement of operations at a new facility in Puebla, Mexico, have substantially boosted the company's "retail" segment revenue. This trend is expected to continue as AMS focuses on expanding its international footprint, particularly in Latin America, and shifting towards a patient-centric service model.
2. Growth in Proton Beam Radiation Therapy (PBRT): AMS has expanded its financing model beyond Gamma Knife to include other advanced radiation therapy solutions, such as Proton Beam Radiation Therapy (PBRT). While the leasing segment has experienced some fluctuations, the company has seen increases in total proton beam radiation therapy revenue, indicating continued growth in this specialized and high-value treatment area.
3. International Market Expansion: The company is actively focusing on expanding its international presence. The new facility in Puebla, Mexico, is a clear example of this strategy, contributing to the significant increase in direct patient services revenue. This geographic expansion into new markets is expected to be a key component of future revenue growth.
4. Transition to Patient-Centric Service Model: AMS is actively transitioning its business model from primarily equipment leasing to a more patient-centric service model through its direct patient services segment. This shift allows the company to capture more direct revenue from treatments rather than solely relying on equipment leases, which have seen some contracts expire. The substantial growth in the direct patient services segment underscores the success and future potential of this strategic pivot.

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1. Share Issuance
   • In June 2021, American Shared Hospital Services' shareholders approved an amendment to the Incentive Compensation Plan, increasing the number of common shares reserved for issuance under the plan to 2,580,000.
   • The number of outstanding shares of common stock increased from 5,868,000 as of August 10, 2021, to 6,112,000 as of August 10, 2022.
2. Outbound Investments
   • Strategic expansion includes the acquisition of three radiation therapy treatment centers in Rhode Island and a new facility in Puebla, Mexico.
   • A new Esprit system was installed in Guadalajara, Mexico.
   • The company engages in international joint ventures in Latin America.
3. Capital Expenditures
   • Capital expenditures were $0 million in 2020, $2 million in 2021, $0 million in 2022, $6 million in 2023, and $8 million in 2024.
   • Projected capital expenditures are $4 million for 2025 and $5 million annually from 2026 to 2029.
   • The primary focus of capital expenditures includes Gamma Knife reloads and financing future projects related to advanced cancer treatment technologies.