American Shared Hospital Services (AMS) 10-Q 13 Nov 20 2020 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2020	Nov. 02, 2020
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2020
Document Transition Report	false
Entity File Number	001-08789
Entity Registrant Name	American Shared Hospital Services
Entity Incorporation, State or Country Code	CA
Entity Tax Identification Number	94-2918118
Entity Address, Address Line One	Two Embarcadero Center,
Entity Address, Address Line Two	Suite 410
Entity Address, City or Town	San Francisco,
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	94111
City Area Code	415
Local Phone Number	788-5300
Title of 12(b) Security	American Shared Hospital Services Common Stock, No Par Value
Trading Symbol	AMS
Security Exchange Name	NYSEAMER
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		5,761,000
Amendment Flag	false
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q2
Entity Central Index Key	0000744825
Current Fiscal Year End Date	--12-31

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 3,619	$ 1,429
Restricted cash	364	350
Accounts receivable, net of allowance for doubtful accounts of $100,000 at September 30, 2020 and $100,000 at December 31, 2019	5,214	6,894
Other receivables	472	169
Prepaid expenses and other current assets	1,291	1,900
Total current assets	10,960	10,742
Property and equipment:
Medical equipment and facilities	88,729	92,132
Office equipment	339	594
Deposits and construction in progress	4,661	4,215
Property and equipment, gross	93,729	96,941
Accumulated depreciation and amortization	(54,943)	(55,461)
Net property and equipment	38,786	41,480
Goodwill	1,265	0
Right of use assets	959	1,106
Intangible asset	78	0
Other assets	292	455
Total assets	52,340	53,783
Current liabilities:
Accounts payable	898	557
Employee compensation and benefits	441	234
Other accrued liabilities	1,823	1,779
Income taxes payable	126	130
Working capital payment due	397	0
Current portion of lease liabilities	299	279
Current portion of long-term debt	1,216	1,526
Current portion of finance leases	2,827	3,709
Total current liabilities	8,027	8,214
Long-term lease liabilities, less current portion	660	827
Long-term debt, less current portion	3,721	1,954
Long-term finance leases, less current portion	6,605	8,177
Deferred revenue, less current portion	225	286
Deferred income taxes	2,388	2,514
Shareholders' equity:
Common stock, no par value (10,000,000 authorized; 5,751,000 and 5,817,000 shares issued and outstanding at September 30, 2020 and at December 31, 2019, respectively)	10,753	10,753
Additional paid-in capital	6,914	6,725
Retained earnings	7,728	8,555
Total equity-American Shared Hospital Services	25,395	26,033
Non-controlling interests in subsidiaries	5,319	5,778
Total shareholders' equity	30,714	31,811
Total liabilities and shareholders' equity	$ 52,340	$ 53,783

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) [Parenthetical] - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Allowance for doubtful accounts (in dollars)	$ 100	$ 100
Common stock, par value (in dollars)	$ 0	$ 0
Common stock, shares authorized (in shares)	10,000,000	10,000,000
Common Stock
Common stock, shares issued (in shares)	5,751,000	5,817,000
Common stock, shares outstanding (in shares)	5,751,000	5,817,000

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Revenues	$ 4,670	$ 5,301	$ 13,229	$ 15,819
Costs of revenue:
Maintenance and supplies	562	648	1,748	1,968
Depreciation and amortization	1,819	1,817	5,103	5,719
Other direct operating costs	1,151	1,023	2,939	2,653
Cost and expenses	3,532	3,488	9,790	10,340
Gross margin	1,138	1,813	3,439	5,479
Selling and administrative expense	1,135	1,065	3,556	3,201
Interest expense	254	302	803	1,015
Operating (loss) income	(251)	446	(920)	1,263
Interest and other income	3	7	7	15
(Loss) income before income taxes	(248)	453	(913)	1,278
Income tax (benefit) expense	(34)	99	(192)	250
Net (loss) income	(214)	354	(721)	1,028
Less: Net loss (income) attributable to non-controlling interest	5	(189)	(106)	(562)
Net (loss) income attributable to American Shared Hospital Services	$ (209)	$ 165	$ (827)	$ 466
Net (loss) income per share:
(Loss) earnings per common share - basic (in USD per share)	$ (0.03)	$ 0.03	$ (0.14)	$ 0.08
(Loss) earnings per common share - diluted (in USD per share)	$ (0.03)	$ 0.03	$ (0.14)	$ 0.08

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENT OF SHAREHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Retained Earnings	Sub-Total ASHS	Non-controlling Interests in Subsidiaries
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance (in shares)		5,714,000
Beginning balance (in shares) at Dec. 31, 2018		5,714,000
Beginning balance at Dec. 31, 2018	$ 31,048	$ 10,711	$ 6,495	$ 7,896	$ 25,102	$ 5,946
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	55		55		55
Stock-based compensation expense	55		55		55
Cash distributions to non-controlling interests	(19)					(19)
Net (loss) income	395			270	270	125
Ending balance (in shares) at Mar. 31, 2019		5,714,000
Ending balance at Mar. 31, 2019	31,479	$ 10,711	6,550	8,166	25,427	6,052
Beginning balance (in shares) at Dec. 31, 2018		5,714,000
Beginning balance at Dec. 31, 2018	$ 31,048	$ 10,711	6,495	7,896	25,102	5,946
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Options exercised (in shares)	16,000
Net (loss) income	$ 1,028
Ending balance (in shares) at Sep. 30, 2019		5,816,000
Ending balance at Sep. 30, 2019	31,422	$ 10,752	6,665	8,362	25,779	5,643
Beginning balance (in shares) at Mar. 31, 2019		5,714,000
Beginning balance at Mar. 31, 2019	31,479	$ 10,711	6,550	8,166	25,427	6,052
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	$ 53		53		53
Stock based compensation expense (in shares)	86,000
Stock-based compensation expense	$ 53		53		53
Cash distributions to non-controlling interests	(57)					(57)
Net (loss) income	279			31	31	248
Ending balance (in shares) at Jun. 30, 2019		5,800,000
Ending balance at Jun. 30, 2019	31,754	$ 10,711	6,603	8,197	25,511	6,243
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	62		62		62
Options exercised (in shares)		16,000
Options exercised	41	$ 41			41
Stock-based compensation expense	62		62		62
Cash distributions to non-controlling interests	(789)					(789)
Net (loss) income	354			165	165	189
Ending balance (in shares) at Sep. 30, 2019		5,816,000
Ending balance at Sep. 30, 2019	31,422	$ 10,752	6,665	8,362	25,779	5,643
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance (in shares)		5,817,000
Beginning balance (in shares) at Dec. 31, 2019		5,817,000
Beginning balance at Dec. 31, 2019	31,811	$ 10,753	6,725	8,555	26,033	5,778
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	56		56		56
Options exercised (in shares)		(129,000)
Stock-based compensation expense	56		56		56
Cash distributions to non-controlling interests	(326)					(326)
Net (loss) income	(68)			(135)	(135)	67
Ending balance (in shares) at Mar. 31, 2020		5,688,000
Ending balance at Mar. 31, 2020	31,473	$ 10,753	6,781	8,420	25,954	5,519
Beginning balance (in shares) at Dec. 31, 2019		5,817,000
Beginning balance at Dec. 31, 2019	31,811	$ 10,753	6,725	8,555	26,033	5,778
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(721)
Ending balance (in shares) at Sep. 30, 2020		5,751,000
Ending balance at Sep. 30, 2020	30,714	$ 10,753	6,914	7,728	25,395	5,319
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance (in shares)		5,688,000
Beginning balance (in shares) at Mar. 31, 2020		5,688,000
Beginning balance at Mar. 31, 2020	31,473	$ 10,753	6,781	8,420	25,954	5,519
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	53		53		53
Stock based compensation expense (in shares)		3,000
Stock-based compensation expense	53		53		53
Cash distributions to non-controlling interests	(114)					(114)
Net (loss) income	(439)			(483)	(483)	44
Ending balance (in shares) at Jun. 30, 2020		5,691,000
Ending balance at Jun. 30, 2020	30,973	$ 10,753	6,834	7,937	25,524	5,449
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance (in shares)		5,691,000
Stock-based compensation expense	80		80		80
Stock based compensation expense (in shares)		60,000
Stock-based compensation expense	80		80		80
Cash distributions to non-controlling interests	(142)					(142)
NCI investment in Acquisition	17					17
Net (loss) income	(214)			(209)	(209)	(5)
Ending balance (in shares) at Sep. 30, 2020		5,751,000
Ending balance at Sep. 30, 2020	$ 30,714	$ 10,753	$ 6,914	$ 7,728	$ 25,395	$ 5,319
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance (in shares)		5,751,000

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2020	Mar. 31, 2020	Sep. 30, 2019	Mar. 31, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2018
Operating activities:
Net (loss) income	$ (214)	$ (68)	$ 354	$ 395	$ (721)	$ 1,028
Adjustments to reconcile net (loss) income to net cash from operating activities (excluding assets acquired and liabilities assumed):
Depreciation and amortization					5,209	5,772
Non cash lease expense					215	189
Deferred income taxes					(192)	(214)
Stock-based compensation expense	80		62		189	170	$ 108
Accrued interest on lease financing					0	9
Interest expense associated with lease liabilities					52	59
Changes in operating assets and liabilities:
Receivables					2,242	(896)
Prepaid expenses and other assets					687	(559)
Accounts payable, accrued liabilities and deferred revenue					784	817
Income taxes payable					(141)	0
Lease liability					(267)	(248)
Net insurance proceeds receivable					0	160
Net cash provided by operating activities					8,057	6,287
Investing activities:
Payment for purchase of property and equipment					(328)	(889)
Payment for acquisition, net of cash acquired					(2,084)	0
Proceeds from sale of equipment					150	0
Net cash used in investing activities					(2,262)	(889)
Financing activities:
Principal payments on long-term debt					(1,386)	(1,564)
Principal payments on finance leases					(2,559)	(3,155)
Principal payments on short-term financing					(459)	0
Distributions to non-controlling interests					(582)	(865)
Proceeds from options exercised					0	41
Proceeds from financing for acquisition					1,425	0
Debt issuance costs long-term debt					(30)	0
Net cash used in financing activities					(3,591)	(5,543)
Net change in cash, cash equivalents, and restricted cash					2,204	(145)
Cash, cash equivalents, and restricted cash at beginning of period		$ 1,779		$ 1,792	1,779	1,792
Cash, cash equivalents, and restricted cash at end of period	$ 3,983		$ 1,647		3,983	1,647	$ 1,792
Supplemental cash flow disclosure:
Interest					803	1,015
Income taxes paid					335	418
Schedule of non-cash investing and financing activities
Lease reassessment right of use assets and lease liabilities					67	0
Right of use assets and lease liabilities					135	1,362
Interest capitalized to property and equipment					97	82
Acquisition of equipment with finance leases					369	1,293
Acquisition of equipment with long-term debt financing					1,184	0
Acquisition of insurance with short-term financing					45	0
First working capital payment related to acquisition, witholding taxes					43	0
Estimated subsequent working capital payment for acquisition					$ 354	$ 0

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation In the opinion of management, the accompanying unaudited condensed consolidated financial statements contain all adjustments necessary for the fair presentation of American Shared Hospital Services’ consolidated financial position as of September 30, 2020, the results of its operations for the three and nine-month periods ended September 30, 2020 and September 30, 2019, and the cash flows for the three and nine-month periods ended September 30, 2020 and September 30, 2019. The results of operations for the three and nine-months ended September 30, 2020 are not necessarily indicative of results on an annualized basis. Consolidated balance sheet amounts as of December 31, 2019 have been derived from audited consolidated financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements for the year ended December 31, 2019 included in American Shared Hospital Services’ Annual Report on Form 10-K filed with the Securities and Exchange Commission. These condensed consolidated financial statements include the accounts of American Shared Hospital Services and its subsidiaries (the “Company”) as follows: the Company wholly-owns the subsidiaries American Shared Radiosurgery Services (“ASRS”), PBRT Orlando, LLC (“Orlando”), OR21, Inc., and MedLeader.com, Inc. (“MedLeader”); the Company is the majority owner of Long Beach Equipment, LLC (“LBE”); ASRS is the majority-owner of GK Financing, LLC (“GKF”) which wholly-owns the subsidiary Instituto de Gamma Knife del Pacifico S.A.C. (“GKPeru”) and HoldCo GKC S.A. (“HoldCo”). GKF is the majority owner of the subsidiaries Albuquerque GK Equipment, LLC (“AGKE”), Jacksonville GK Equipment, LLC (“JGKE”) and Gamma Knife Center Ecuador S.A. (“GKCE”). The Company (through ASRS) and Elekta AB, the manufacturer of the Gamma Knife (through its wholly-owned United States subsidiary, GKV Investments, Inc.), entered into an operating agreement and formed GKF. As of September 30, 2020, GKF provides Gamma Knife units to fifteen medical centers in the United States in the states of Arkansas, California, Florida, Illinois, Indiana, Massachusetts, Mississippi, Nebraska, New Mexico, New York, Ohio, Oregon, Tennessee, and Texas. GKF also owns and operates single-unit Gamma Knife facilities in Lima, Peru and Guayaquil, Ecuador. The Company through its wholly-owned subsidiary, Orlando, provided proton beam radiation therapy (“PBRT”) and related equipment to a customer in the United States. The Company formed the subsidiaries GKPeru for the purposes of expanding its business internationally; Orlando and LBE to provide PBRT equipment and services in Orlando, Florida and Long Beach, California, respectively; and AGKE and JGKE to provide Gamma Knife equipment and services in Albuquerque, New Mexico and Jacksonville, Florida, respectively. AGKE began operations in the second quarter of 2011 and JGKE began operations in the fourth quarter of 2011. Orlando treated its first patient in April 2016. GKPeru treated its first patient in July 2017. LBE is not expected to generate revenue within the next two years. On June 12, 2020, GKF purchased approximately 98% of the total outstanding shares of GKCE, from GKCE’s majority shareholders (the “Acquisition”). As of September 30, 2020, the Company acquired approximately 99.3% of the total outstanding shares of GKCE and intends to acquire the remaining 0.7% at a later date. The base purchase price for the Acquisition, including acquisition of the minority shares was approximately $2,000,000. This purchase price was paid with $575,000 in cash and a $1,425,000 loan from the United States International Development Finance Corporation (“DFC”). The purchase price is subject to certain post-closing adjustments, including adjustment for GKCE's working capital and excess cash. The DFC loan is denominated in U.S. dollars, which is also the currency of Ecuador. See “Note 9. GKCE Acquisition” for further discussion. The Company continues to develop its design and business model for The Operating Room for the 21st Century SM through its 50% owned OR21, LLC (“OR21 LLC”). The remaining 50% is owned by an architectural design company. OR21 LLC is not expected to generate significant revenue for at least the next two years. MedLeader was formed to provide continuing medical education online and through videos for doctors, nurses, and other healthcare workers. This subsidiary is not operational at this time. All significant intercompany accounts and transactions have been eliminated in consolidation. The Company is subject to risks and uncertainties as a result of the COVID-19 pandemic and the extent and duration of the future impact on the Company's business is highly uncertain and difficult to predict. The COVID-19 pandemic has adversely impacted, and is likely to further adversely impact, nearly all aspects of the Company’s business and markets, including its employees, operations, contractors, customers, government and third party payors and others. The full extent to which the pandemic will directly or indirectly impact the Company's business, results of operations and financial condition will depend on future developments that are highly uncertain and difficult to predict. Accounting Pronouncements Issued and Adopted In February 2018, the FASB issued ASU No. 2018-03 Recognition and Measurement of Financial Assets and Financial Liabilities (“ASU 2018-03”), which clarifies certain aspects of ASU 2016-1. These are: equity securities without a readily determinable fair value – discontinuation, equity securities without a readily determinable fair value – adjustments, forward contracts and purchased options, presentation requirements for certain fair value option liabilities, fair value option liabilities denominated in a foreign currency, and transition guidance for equity securities without a readily determinable fair value. In August 2018, the FASB issued ASU No. 2018-13 Fair Value Measurement (Topic 820): Disclosure Framework – Changes to the Disclosure Requirements to Fair Value Measurement (“ASU 2018-13”), which amended the effective date and other certain measurement aspects of ASU 2018-03. The new guidance is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2019. The Company adopted ASU 2018-03 and ASU 2018-13 on January 1, 2020. There was no significant impact on its condensed consolidated financial statements and related disclosures. Accounting Pronouncements Issued and Not Yet Adopted In December 2019, the FASB issued ASU 2019-12 Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”) which removes specific exceptions to the general principles in Topic 740 and eliminates the need for an organization to analyze whether the following apply in a given period: exception to the incremental approach for intraperiod tax allocation; exceptions to accounting for basis differences when there are ownership changes in foreign investments; exception in interim period income tax accounting for year-to-date losses that exceed anticipated losses. The new guidance is effective for fiscal years and interim periods beginning after December 15, 2020. The Company is currently evaluating ASU 2019-12 to determine the impact it may have on its consolidated financial statements.

Property and Equipment

Property and Equipment	9 Months Ended
	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment are stated at cost less accumulated depreciation. Depreciation for Gamma Knife units, Image Guided Radiation Therapy (“IGRT”) equipment, and other equipment is determined using the straight-line method over the estimated useful lives of the assets, which for medical and office equipment is generally 3 – 10 years, and after accounting for salvage value on the equipment where indicated. Salvage value is based on the estimated fair value of the equipment at the end of its useful life. Depreciation for PBRT equipment is determined using the modified units of production method, which is a function of both time and usage of the equipment. This depreciation method allocates costs considering the projected volume of usage through the useful life of the PBRT unit, which has been estimated at 20 years. The estimated useful life of the PBRT unit is consistent with the estimated economic life of 20 years. The following table summarizes property and equipment as of September 30, 2020 and December 31, 2019: September 30, December 31, 2020 2019 Medical equipment and facilities $ 88,729,000 $ 92,132,000 Office equipment 339,000 594,000 Deposits and construction in progress 2,411,000 1,965,000 Deposits towards purchase of proton beam systems 2,250,000 2,250,000 93,729,000 96,941,000 Accumulated depreciation (54,943,000) (55,461,000) Net property and equipment $ 38,786,000 $ 41,480,000 As of September 30, 2020, approximately $3,343,000 of the net property and equipment balance is outside of the United States. As of September 30, 2020, the Company has two idle Gamma Knife units with a cumulative net book value of $943,000. There are currently no commitments to place into service or trade in these units during 2020.

Long-Term Debt Financing

Long-Term Debt Financing	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Long-term Debt Financing	Long-Term Debt FinancingLong-term debt consists of seven notes with three financing companies collateralized by the Gamma Knife units, the individual customer contracts, and related accounts receivable at September 30, 2020. The Company’s loan with DFC for the Acquisition was obtained through the Company’s wholly-owned subsidiary, HoldCo and is guaranteed by GKF. As of September 30, 2020, long-term debt on the Condensed Consolidated Balance Sheets was $4,937,000. See disclosure of future payments below under the heading “Commitments”.

Finance Leases

Finance Leases	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Finance Leases	Finance LeasesFinance lease obligations consist of seven leases with two financing companies, collateralized by Gamma Knife units and PBRT equipment, the individual customer contracts, and related accounts receivable at September 30, 2020. As of September 30, 2020, obligations under finance leases on the Condensed Consolidated Balance Sheets were $9,432,000. See disclosure of future payments below under the heading “Commitments”.

Leases

Leases	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Leases	Leases The Company determines if a contract is a lease at inception. Under ASC 842 Leases (“ASC 842”), the Company is a lessor of equipment to various customers. Leases that commenced prior to ASC 842 adoption date were classified as operating leases under historical guidance. As the Company has elected the package of practical expedients allowing to not reassess lease classification, these leases are classified as operating leases under ASC 842 as well. All of the Company’s lessor arrangements entered into after ASC 842 adoption are also classified as operating leases. Some of these lease terms have an option to extend the lease after the initial term, but do not contain the option to terminate early or purchase the asset at the end of the term. The Company’s Gamma Knife and PBRT contracts with hospitals are classified as operating leases under ASC 842. The related equipment is included in medical equipment and facilities on the Company’s condensed consolidated balance sheets. As all income from the Company’s lessor arrangements is solely based on procedure volume, all income is considered variable payments not dependent on an index or a rate. As such, the Company does not measure future operating lease receivables. The Company’s lessee operating leases are accounted for as right-of-use (“ROU”) assets, other current liabilities, and lease liabilities on the condensed consolidated balance sheets. Operating lease ROU assets and liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. The Company’s operating lease contracts do not provide an implicit rate for calculating the present value of future lease payments. The Company determined its incremental borrowing rate, to be in the range of approximately 4.0% and 6.0%, by using available market rates and expected lease terms. The operating lease ROU assets and liabilities also include any lease payments made and excludes lease incentives and initial direct costs incurred. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term. The Company’s lessee operating lease agreements are for administrative office space and related equipment, and the agreement to lease clinic space for its stand-alone facility in Lima, Peru. These leases have remaining lease terms between 3 and 4 years, some of which include options to renew or extend the lease. As of September 30, 2020, operating ROU assets and liabilities were $959,000. During the nine-month period ended September 30, 2020, the Company elected to not renew its lease for a satellite office in Fairfield, California. The Company previously included the renewal term in its assessment of the lease term for the ROU asset and liability. The Company accounted for this change as a lease reassessment under ASC 842. At the reassessment date, the remaining lease balance was not material to the Company's condensed consolidated balance sheets and the Company wrote off the related ROU assets and liabilities of $67,000. During the nine-month period ended September 30, 2020, the Company agreed to a rent increase for its clinic space for its stand-alone facility in Lima, Peru. The rent increase was effective as of January 1, 2020 and the Company increased the related ROU assets and liabilities by $135,000. The following table summarizes maturities of lessee operating lease liabilities as of September 30, 2020: Year ending December 31, Operating Leases 2020 (excluding the nine-months ended September 30, 2020) $ 86,000 2021 346,000 2022 353,000 2023 248,000 2024 8,000 Total lease payments 1,041,000 Less imputed interest (82,000) Total $ 959,000

Per Share Amounts

Per Share Amounts	9 Months Ended
	Sep. 30, 2020
Earnings Per Share [Abstract]
Per Share Amounts	Per Share Amounts Per share information has been computed based on the weighted average number of common shares and dilutive common share equivalents outstanding. Based on the guidance provided in accordance with ASC 260 Earnings Per Share (“ASC 260”), potentially dilutive common stock equivalents, such as diluted stock options, are not considered when their inclusion in reporting earnings per share would be dilutive to reported losses incurred per share. Because the Company reported a loss for the three and nine-month periods ended September 30, 2020, the potentially dilutive effects of approximately 10,000, of the Company’s stock options and 31,000 of the Company's unvested restricted stock awards were not considered for the reporting periods. The computation for the three and nine-month periods ended September 30, 2019 excluded approximately 513,000, of the Company's stock options because the exercise price of the options was higher than the average market price during those periods. During the three-month period ended June 30, 2020, the Company appointed Raymond C. Stachowiak as Interim President and Chief Executive Officer (“Interim CEO”). As part of his Offer Letter, the Interim CEO was granted 50,000 restricted stock awards that vested in full on August 3, 2020. In addition, since the Interim CEO continued to serve the Company after August 3, 2020, he was granted additional restricted stock awards totaling 10,000 common shares, which vest in full at the end of each 30-day period after August 3, 2020. On October 1, 2020 the Interim CEO was appointed the Chief Executive Officer (“CEO”). For the three and nine-month periods ended September 30, 2020, 60,000 restricted stock awards were issued to the CEO and fully vested. During the three-month period ended September 30, 2020, Ernest R. Bates, Senior Vice President, Sales and Business Development, International Operations, was awarded 10,000 restricted stock awards, which will vest on December 31, 2020. On March 31, 2020, the Company’s Award Agreements (as defined below) expired and the unvested performance share awards were returned to the Company’s stock incentive plan - see Note 7 for further discussion. Based on the guidance provided in accordance with ASC 260, the weighted average common shares for basic earnings per share, for the three and nine-month periods ended September 30, 2019, excluded the weighted average impact of the unvested performance share awards. These awards were legally outstanding but not deemed participating securities and therefore were excluded from the calculation of basic earnings per share. The unvested shares were also excluded from the denominator for diluted earnings per share because they were considered contingent shares not deemed probable as of September 30, 2019. The following table sets forth the computation of basic and diluted earnings per share for the three and nine-month periods ended September 30, 2020 and 2019: Three Months ended September 30, Nine Months ended September 30, 2020 2019 2020 2019 Net (loss) income attributable to American Shared Hospital Services $ (209,000) $ 165,000 $ (827,000) $ 466,000 Weighted average common shares for basic earnings per share 6,049,000 5,889,000 6,060,000 5,899,000 Diluted effect of stock options and restricted stock awards — 19,000 — 18,000 Weighted average common shares for diluted earnings per share 6,049,000 5,908,000 6,060,000 5,917,000 Basic (loss) earnings per share $ (0.03) $ 0.03 $ (0.14) $ 0.08 Diluted (loss) earnings per share $ (0.03) $ 0.03 $ (0.14) $ 0.08

Stock-based Compensation

Stock-based Compensation	9 Months Ended
	Sep. 30, 2020
Share-based Payment Arrangement [Abstract]
Stock-based Compensation	Stock-based Compensation In June 2010, the Company’s shareholders approved an amendment and restatement of the Company’s stock incentive plan, renaming it the Incentive Compensation Plan (the “Plan”), and among other things, increasing the number of shares of the Company’s common stock reserved for issuance under the Plan to 1,630,000. The Plan provides that the shares reserved under the Plan are available for issuance to officers of the Company, other key employees, non-employee directors, and advisors. No further grants or share issuances will be made under the previous plans. On June 21, 2019, the Company’s shareholders approved an amendment and restatement of the Plan in order to extend the term of the Plan by two years to February 22, 2022. Stock-based compensation expense associated with the Company’s stock options to employees is calculated using the Black-Scholes valuation model. The Company’s stock awards have characteristics significantly different from those of traded options, and changes in the subjective input assumptions can materially affect the fair value estimates. The estimated fair value of the Company’s option grants is estimated using assumptions for expected life, volatility, dividend yield, and risk-free interest rate which are specific to each award. The estimated fair value of the Company’s options is expensed over the period during which an employee is required to provide service in exchange for the award (requisite service period), usually the vesting period. Accordingly, stock-based compensation cost before income tax effect for the Company’s options and restricted stock awards in the amount of $80,000 and $189,000 is reflected in net loss for the three and nine-month periods ended September 30, 2020 compared to $62,000 and $170,000 in the same periods of the prior year, respectively. At September 30, 2020, there was approximately $16,000 of unrecognized compensation cost related to non-vested share-based compensation arrangements granted under the Plan, excluding unrecognized compensation cost associated with the performance share awards, discussed below. This cost is expected to be recognized over a period of approximately three years. On January 4, 2017, the Company entered into a Performance Share Award Agreement with three executive officers of the Company (the “Award Agreements”) for 161,766 restricted stock awards which vest upon the achievement of certain performance metrics. The Award Agreements expired on March 31, 2020. Based on the guidance in ASC 718 Stock Compensation (“ASC 718”), the Company concluded these were performance-based awards with vesting criteria tied to performance metrics. As of December 31, 2018, the Company achieved one of those certain performance metrics under the Award Agreements and recognized stock compensation expense of approximately $108,000 related to these awards. The unrecognized stock-based compensation expense for these awards was approximately $434,000 and the unvested awards of approximately 129,000 shares were returned to the Plan as of March 31, 2020. The following table summarizes stock option activity for the nine-month periods ended September 30, 2020 and 2019: Stock Grant Date Weighted- Intrinsic Outstanding at January 1, 2020 450,000 $ 2.78 2.44 $ 27,000 Granted 10,000 $ 1.88 7.00 $ — Forfeited (40,000) $ 2.58 — $ — Outstanding at September 30, 2020 420,000 $ 2.78 1.86 $ — Exercisable at September 30, 2020 403,000 $ 2.80 1.69 $ — Outstanding at January 1, 2019 613,000 $ 2.85 3.18 $ — Granted 18,000 $ 2.91 7.00 $ — Exercised (16,000) $ 2.59 — $ — Forfeited (12,000) $ 3.05 — $ — Outstanding at September 30, 2019 603,000 $ 2.86 2.09 $ 42,000 Exercisable at September 30, 2019 478,000 $ 2.86 1.97 $ —

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2020
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The Company generally calculates its effective income tax rate at the end of an interim period using an estimate of the annualized effective income tax rate expected to be applicable for the full fiscal year. However, when a reliable estimate of the annualized effective income tax rate cannot be made, the Company computes its provision for income taxes using the actual effective income tax rate for the results of operations reported within the year-to-date periods. The Company’s effective income tax rate is highly influenced by relative income or losses reported and the amount of the nondeductible stock-based compensation associated with grants of its common stock options and from the results of foreign operations. A small change in estimated annual pretax income (loss) can produce a significant variance in the annualized effective income tax rate given the expected amount of these items. As a result, the Company has computed its provision for income taxes for the three and nine-month periods ended September 30, 2020 by applying the actual effective tax rates to income or (loss) reported within the condensed consolidated financial statements through those periods. On March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief and Economic Security Act (“CARES Act”). The CARES Act, among other things, includes provisions relating to refundable payroll tax credits, deferment of employer side social security payments, net operating loss carryback periods, alternative minimum tax credit refunds, modifications to the net interest deduction limitations and technical corrections to tax depreciation methods for qualified improvement property. Under ASC 740 Income Taxes , the effects of new legislation are recognized upon enactment. Accordingly, the effects of the CARES Act were effective for the Company for the three-month reporting period ended March 31, 2020, and for subsequent reporting periods. The CARES Act did not have a material impact on the Company's financial statements.

GKCE Acquisition

GKCE Acquisition	9 Months Ended
	Sep. 30, 2020
Business Combinations [Abstract]
GKCE Acquisition	GKCE Acquisition On June 18, 2019, the Company entered into a Stock Purchase Agreement (the “Agreement”) to acquire Gamma Knife Center Ecuador S.A. (“GKCE”) from GKCE’s selling majority shareholders. GKCE is a well-established Gamma Knife operation founded in 2009 as a private clinic to introduce advanced stereotactic radiosurgery into Ecuador and continues to operate the only Gamma Knife unit in the country. The Company acquired GKCE for the continued expansion of its business internationally. On June 12, 2020 (the “Closing Date”), the Company acquired approximately 98% of the total outstanding shares of GKCE. As of September 30, 2020, the Company acquired approximately 99.3% of the total outstanding shares of GKCE and intends to acquire the remaining 0.7% at a later date. The fair value of the non-controlling interests (“NCI”) on the Closing Date was approximately $58,000, which was consistent with the purchase price in the executed NCI agreements. The total purchase consideration for 100% of the outstanding shares of GKCE was $2,869,000, including $2,000,000 of base purchase price, subject to certain price adjustments for current assets and liabilities and tax withholding. The base purchase price of $2,000,000 was paid with $575,000 of cash and a $1,425,000 loan from the United States International Development Finance Corporation (“DFC”). The DFC loan is denominated in U.S. dollars, which is also the currency of Ecuador. The price adjustments will be paid by the Company in the post-closing period with the adjustments related to the amount of working capital that GKCE had as of the Closing Date. The first price adjustment for working capital as of the Closing Date was approximately $515,000, which was paid by the Company in August 2020. As of September 30, 2020, the Company owes the withholding taxes related to this payment totaling approximately $43,000. The Company estimates an additional contingent consideration of approximately $354,000 will be remitted to the seller based on the collection of Closing Date accounts receivable balances, net of related costs, during the three-month, six-month and twelve-month periods after the Closing Date. The Company reviewed historical patient treatments, invoice, and collection data from GKCE to determine an appropriate estimate of the contingent consideration at the Closing Date. The acquisition has been accounted for according to ASC 805 Business Combinations using the acquisition method. Under the acquisition method of accounting, all assets acquired, including goodwill and other intangible assets, should be stated on the financial statements at fair value. The allocation of purchase price consideration is preliminary, pending the completion of the fair value of certain tangible, intangible assets, and residual goodwill. During the measurement period, which can be no more than one year from the Closing Date, the Company expects to continue to obtain information to assist in determining the final fair value of assets acquired. The assets acquired were recorded based on valuations derived from estimated fair value assessments and assumptions used by the Company. Thus, the provisional measurements of fair value discussed below are subject to change. The Company expects to finalize the valuation as soon as practicable, but no later than one year from the Closing Date. While the Company believes its estimates and assumptions underlying the valuations are reasonable, different estimates and assumptions could result in different valuations assigned to the individual assets acquired, and the resulting amount of goodwill. The major classes of assets and liabilities to which the Company has preliminarily allocated the fair value of purchase price consideration were as follows: June 12, 2020 Cash and cash equivalents $ 432,000 Accounts receivable 827,000 Prepaid expense and other 22,000 Building 404,000 Medical equipment 319,000 Purchased intangible assets 78,000 Goodwill 1,265,000 Total assets acquired $ 3,347,000 Accounts payable (193,000) Income taxes payable (136,000) Deferred income taxes (66,000) Employee compensation and benefits (83,000) Total liabilities assumed $ (478,000) Consideration allocated to assets acquired and liabilities assumed $ 2,869,000 First working capital payment $ (515,000) Estimated subsequent working capital payment (354,000) Base purchase consideration $ 2,000,000 The Company has allocated the purchase price of GKCE to the tangible assets, liabilities, and intangible asset acquired, based on their estimated fair values. Goodwill of $1,265,000 represents the excess of the purchase price consideration over the fair value of the identifiable tangible and intangible assets assumed of $801,000. The Company believes the amount of goodwill resulting from the acquisition is primarily attributable to expected synergies from an assembled and trained workforce and enhanced opportunities for growth and innovation. The goodwill resulting from the acquisition is not tax deductible. The preliminary value of the acquired tangible assets acquired are as follows: Fair Value Useful Life (in Years) Building $ 404,000 20 Medical equipment 302,000 2 Other fixed assets 17,000 2 Total tangible assets $ 723,000 The Company also acquired intangible assets with a fair value of $78,000. The intangible asset identified was GKCE's trade name and the Company assigned an indefinite useful life to the asset. The Company incurred costs related to the acquisition of approximately $93,000 for the three-month period ended June 30, 2020 and $69,000 for the three-month period ended September 30, 2020. All acquisition related costs were expensed as incurred and have been recorded in selling and administrative expense in the Company's condensed consolidated statement of operations.

Basis of Presentation (Policies

Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation In the opinion of management, the accompanying unaudited condensed consolidated financial statements contain all adjustments necessary for the fair presentation of American Shared Hospital Services’ consolidated financial position as of September 30, 2020, the results of its operations for the three and nine-month periods ended September 30, 2020 and September 30, 2019, and the cash flows for the three and nine-month periods ended September 30, 2020 and September 30, 2019. The results of operations for the three and nine-months ended September 30, 2020 are not necessarily indicative of results on an annualized basis. Consolidated balance sheet amounts as of December 31, 2019 have been derived from audited consolidated financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements for the year ended December 31, 2019 included in American Shared Hospital Services’ Annual Report on Form 10-K filed with the Securities and Exchange Commission. These condensed consolidated financial statements include the accounts of American Shared Hospital Services and its subsidiaries (the “Company”) as follows: the Company wholly-owns the subsidiaries American Shared Radiosurgery Services (“ASRS”), PBRT Orlando, LLC (“Orlando”), OR21, Inc., and MedLeader.com, Inc. (“MedLeader”); the Company is the majority owner of Long Beach Equipment, LLC (“LBE”); ASRS is the majority-owner of GK Financing, LLC (“GKF”) which wholly-owns the subsidiary Instituto de Gamma Knife del Pacifico S.A.C. (“GKPeru”) and HoldCo GKC S.A. (“HoldCo”). GKF is the majority owner of the subsidiaries Albuquerque GK Equipment, LLC (“AGKE”), Jacksonville GK Equipment, LLC (“JGKE”) and Gamma Knife Center Ecuador S.A. (“GKCE”). The Company (through ASRS) and Elekta AB, the manufacturer of the Gamma Knife (through its wholly-owned United States subsidiary, GKV Investments, Inc.), entered into an operating agreement and formed GKF. As of September 30, 2020, GKF provides Gamma Knife units to fifteen medical centers in the United States in the states of Arkansas, California, Florida, Illinois, Indiana, Massachusetts, Mississippi, Nebraska, New Mexico, New York, Ohio, Oregon, Tennessee, and Texas. GKF also owns and operates single-unit Gamma Knife facilities in Lima, Peru and Guayaquil, Ecuador. The Company through its wholly-owned subsidiary, Orlando, provided proton beam radiation therapy (“PBRT”) and related equipment to a customer in the United States. The Company formed the subsidiaries GKPeru for the purposes of expanding its business internationally; Orlando and LBE to provide PBRT equipment and services in Orlando, Florida and Long Beach, California, respectively; and AGKE and JGKE to provide Gamma Knife equipment and services in Albuquerque, New Mexico and Jacksonville, Florida, respectively. AGKE began operations in the second quarter of 2011 and JGKE began operations in the fourth quarter of 2011. Orlando treated its first patient in April 2016. GKPeru treated its first patient in July 2017. LBE is not expected to generate revenue within the next two years. On June 12, 2020, GKF purchased approximately 98% of the total outstanding shares of GKCE, from GKCE’s majority shareholders (the “Acquisition”). As of September 30, 2020, the Company acquired approximately 99.3% of the total outstanding shares of GKCE and intends to acquire the remaining 0.7% at a later date. The base purchase price for the Acquisition, including acquisition of the minority shares was approximately $2,000,000. This purchase price was paid with $575,000 in cash and a $1,425,000 loan from the United States International Development Finance Corporation (“DFC”). The purchase price is subject to certain post-closing adjustments, including adjustment for GKCE's working capital and excess cash. The DFC loan is denominated in U.S. dollars, which is also the currency of Ecuador. See “Note 9. GKCE Acquisition” for further discussion. The Company continues to develop its design and business model for The Operating Room for the 21st Century SM through its 50% owned OR21, LLC (“OR21 LLC”). The remaining 50% is owned by an architectural design company. OR21 LLC is not expected to generate significant revenue for at least the next two years. MedLeader was formed to provide continuing medical education online and through videos for doctors, nurses, and other healthcare workers. This subsidiary is not operational at this time. All significant intercompany accounts and transactions have been eliminated in consolidation.
Accounting Pronouncements Issued	Accounting Pronouncements Issued and Adopted In February 2018, the FASB issued ASU No. 2018-03 Recognition and Measurement of Financial Assets and Financial Liabilities (“ASU 2018-03”), which clarifies certain aspects of ASU 2016-1. These are: equity securities without a readily determinable fair value – discontinuation, equity securities without a readily determinable fair value – adjustments, forward contracts and purchased options, presentation requirements for certain fair value option liabilities, fair value option liabilities denominated in a foreign currency, and transition guidance for equity securities without a readily determinable fair value. In August 2018, the FASB issued ASU No. 2018-13 Fair Value Measurement (Topic 820): Disclosure Framework – Changes to the Disclosure Requirements to Fair Value Measurement (“ASU 2018-13”), which amended the effective date and other certain measurement aspects of ASU 2018-03. The new guidance is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2019. The Company adopted ASU 2018-03 and ASU 2018-13 on January 1, 2020. There was no significant impact on its condensed consolidated financial statements and related disclosures. Accounting Pronouncements Issued and Not Yet Adopted In December 2019, the FASB issued ASU 2019-12 Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”) which removes specific exceptions to the general principles in Topic 740 and eliminates the need for an organization to analyze whether the following apply in a given period: exception to the incremental approach for intraperiod tax allocation; exceptions to accounting for basis differences when there are ownership changes in foreign investments; exception in interim period income tax accounting for year-to-date losses that exceed anticipated losses. The new guidance is effective for fiscal years and interim periods beginning after December 15, 2020. The Company is currently evaluating ASU 2019-12 to determine the impact it may have on its consolidated financial statements.

Property and Equipment (Tables)

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
Summary of property and equipment	The following table summarizes property and equipment as of September 30, 2020 and December 31, 2019: September 30, December 31, 2020 2019 Medical equipment and facilities $ 88,729,000 $ 92,132,000 Office equipment 339,000 594,000 Deposits and construction in progress 2,411,000 1,965,000 Deposits towards purchase of proton beam systems 2,250,000 2,250,000 93,729,000 96,941,000 Accumulated depreciation (54,943,000) (55,461,000) Net property and equipment $ 38,786,000 $ 41,480,000

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Summary of maturities of lessee operating lease	The following table summarizes maturities of lessee operating lease liabilities as of September 30, 2020: Year ending December 31, Operating Leases 2020 (excluding the nine-months ended September 30, 2020) $ 86,000 2021 346,000 2022 353,000 2023 248,000 2024 8,000 Total lease payments 1,041,000 Less imputed interest (82,000) Total $ 959,000

Per Share Amounts (Tables)

Per Share Amounts (Tables)	9 Months Ended
	Sep. 30, 2020
Earnings Per Share [Abstract]
Schedule of earnings per share, basic and diluted	The following table sets forth the computation of basic and diluted earnings per share for the three and nine-month periods ended September 30, 2020 and 2019: Three Months ended September 30, Nine Months ended September 30, 2020 2019 2020 2019 Net (loss) income attributable to American Shared Hospital Services $ (209,000) $ 165,000 $ (827,000) $ 466,000 Weighted average common shares for basic earnings per share 6,049,000 5,889,000 6,060,000 5,899,000 Diluted effect of stock options and restricted stock awards — 19,000 — 18,000 Weighted average common shares for diluted earnings per share 6,049,000 5,908,000 6,060,000 5,917,000 Basic (loss) earnings per share $ (0.03) $ 0.03 $ (0.14) $ 0.08 Diluted (loss) earnings per share $ (0.03) $ 0.03 $ (0.14) $ 0.08

Stock-based Compensation (Table

Stock-based Compensation (Tables)	9 Months Ended
	Sep. 30, 2020
Share-based Payment Arrangement [Abstract]
Summary of stock option activity	The following table summarizes stock option activity for the nine-month periods ended September 30, 2020 and 2019: Stock Grant Date Weighted- Intrinsic Outstanding at January 1, 2020 450,000 $ 2.78 2.44 $ 27,000 Granted 10,000 $ 1.88 7.00 $ — Forfeited (40,000) $ 2.58 — $ — Outstanding at September 30, 2020 420,000 $ 2.78 1.86 $ — Exercisable at September 30, 2020 403,000 $ 2.80 1.69 $ — Outstanding at January 1, 2019 613,000 $ 2.85 3.18 $ — Granted 18,000 $ 2.91 7.00 $ — Exercised (16,000) $ 2.59 — $ — Forfeited (12,000) $ 3.05 — $ — Outstanding at September 30, 2019 603,000 $ 2.86 2.09 $ 42,000 Exercisable at September 30, 2019 478,000 $ 2.86 1.97 $ —

GKCE Acquisition (Tables)

GKCE Acquisition (Tables)	9 Months Ended
	Sep. 30, 2020
Business Combinations [Abstract]
Schedule of purchase price consideration	The major classes of assets and liabilities to which the Company has preliminarily allocated the fair value of purchase price consideration were as follows: June 12, 2020 Cash and cash equivalents $ 432,000 Accounts receivable 827,000 Prepaid expense and other 22,000 Building 404,000 Medical equipment 319,000 Purchased intangible assets 78,000 Goodwill 1,265,000 Total assets acquired $ 3,347,000 Accounts payable (193,000) Income taxes payable (136,000) Deferred income taxes (66,000) Employee compensation and benefits (83,000) Total liabilities assumed $ (478,000) Consideration allocated to assets acquired and liabilities assumed $ 2,869,000 First working capital payment $ (515,000) Estimated subsequent working capital payment (354,000) Base purchase consideration $ 2,000,000
Schedule of tangible assets acquired as part of business combination	The preliminary value of the acquired tangible assets acquired are as follows: Fair Value Useful Life (in Years) Building $ 404,000 20 Medical equipment 302,000 2 Other fixed assets 17,000 2 Total tangible assets $ 723,000

Basis of Presentation (Details

Basis of Presentation (Details Textual) - USD ($) $ in Thousands	Jun. 12, 2020	Sep. 30, 2020
GKCE acquisition
Asset acquisition, percentage of shares acquired	98.00%	99.30%
Asset acquisition, percentage of shares remaining	0.70%
Base purchase consideration	$ 2,000
Payments for asset acquisitions	575
Asset acquisition, transaction costs	$ 1,425
OR21 LLC
Equity method investment, ownership percentage		50.00%
Architectural design company
Equity method investment, ownership percentage		50.00%

Property and Equipment (Details

Property and Equipment (Details Textual) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Net property and equipment	$ 38,786	$ 41,480
Outside of the United States
Property, Plant and Equipment [Line Items]
Net property and equipment	3,343
Gamma Knife
Property, Plant and Equipment [Line Items]
Net property and equipment	$ 943
Medical equipment and facilities | Minimum
Property, Plant and Equipment [Line Items]
Useful life	3 years
Medical equipment and facilities | Maximum
Property, Plant and Equipment [Line Items]
Useful life	10 years
PBRT equipment
Property, Plant and Equipment [Line Items]
Useful life	20 years

Property and Equipment - Summar

Property and Equipment - Summary of Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 93,729	$ 96,941
Accumulated depreciation	(54,943)	(55,461)
Net property and equipment	38,786	41,480
Medical equipment and facilities
Property, Plant and Equipment [Line Items]
Property and equipment, gross	88,729	92,132
Office equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	339	594
Deposits and construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	2,411	1,965
Deposits towards purchase of proton beam systems
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 2,250	$ 2,250

Long-Term Debt Financing (Detai

Long-Term Debt Financing (Details Textual) $ in Thousands	Sep. 30, 2020USD ($)note
Debt Disclosure [Abstract]
Number of debt instruments | note	7
Long-term debt | $	$ 4,937

Finance Leases (Details Textual

Finance Leases (Details Textual) $ in Thousands	Sep. 30, 2020USD ($)lease
Debt Disclosure [Abstract]
Number of financing leases | lease	7
Finance lease obligations | $	$ 9,432

Leases (Details Textual)

Leases (Details Textual) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Operating Leased Assets [Line Items]
Operating lease, right-of-use asset	$ 959		$ 1,106
Operating lease, liability	959
Lease reassessment right of use assets and lease liabilities	67	$ 0
Right of use assets and lease liabilities	$ 135	$ 1,362
Minimum
Operating Leased Assets [Line Items]
Lessee, operating lease, discount rate	4.00%
Remaining lease term	3 years
Maximum
Operating Leased Assets [Line Items]
Lessee, operating lease, discount rate	6.00%
Remaining lease term	4 years

Leases - Summary of Maturities

Leases - Summary of Maturities of Lessee Operating Lease (Details) $ in Thousands	Sep. 30, 2020USD ($)
Leases [Abstract]
2020 (excluding nine-months ended September 30, 2020)	$ 86
2021	346
2022	353
2023	248
2024	8
Total lease payments	1,041
Less imputed interest	(82)
Total	$ 959

Per Share Amounts (Details Text

Per Share Amounts (Details Textual) - shares	Aug. 03, 2020	Sep. 30, 2020	Jun. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Amount of antidilutive securities excluded from computation (in shares)		10,000		513,000	10,000	513,000
Options granted (in shares)					10,000	18,000
Chief Executive Officer
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Restricted stock issued during period (in shares)		60,000			60,000
Senior Vice President
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Restricted stock issued during period (in shares)		10,000
Restricted stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Amount of antidilutive securities excluded from computation (in shares)		31,000			31,000
Options granted (in shares)	10,000		50,000

Per Share Amounts - Schedule of

Per Share Amounts - Schedule of Earnings Per Share, Basic and Diluted (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Earnings Per Share [Abstract]
Net (loss) income attributable to American Shared Hospital Services	$ (209)	$ 165	$ (827)	$ 466
Weighted average common shares for basic earnings per share (in shares)	6,049	5,889	6,060	5,899
Diluted effect of stock options and restricted stock (in shares)	0	19	0	18
Weighted average common shares for diluted earnings per share (in shares)	6,049	5,908	6,060	5,917
Basic (loss) earnings per share (in USD per share)	$ (0.03)	$ 0.03	$ (0.14)	$ 0.08
Diluted (loss) earnings per share (in USD per share)	$ (0.03)	$ 0.03	$ (0.14)	$ 0.08

Stock-based Compensation (Detai

Stock-based Compensation (Details Textual) - USD ($) $ in Thousands	Jan. 04, 2017	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2018	Jun. 30, 2010
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense		$ 80	$ 62	$ 189	$ 170	$ 108
Nonvested awards, unrecognized stock-based compensation expense		434		$ 434
Expected term for cost to be recognized (in years)				3 years
Incentive compensation plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares)							1,630,000
Nonvested awards, unrecognized stock-based compensation expense		$ 16		$ 16
Performance share award agreement
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock awards (in shares)	161,766
Unvested awards (in shares)		129,000		129,000

Stock-based Compensation - Summ

Stock-based Compensation - Summary of Stock Option Activity (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018
Stock Options
Stock options, outstanding beginning balance (in shares)	450	613	613
Stock options, granted (in shares)	10	18
Stock options, exercised (in shares)		(16)
Stock options, forfeited (in shares)	(40)	(12)
Stock options, outstanding ending balance (in shares)	420	603	450	613
Stock options, exercisable (in shares)	403	478
Grant Date Weighted- Average Exercise Price
Grant date weighted-average exercise price, beginning balance (in USD per share)	$ 2.78	$ 2.85	$ 2.85
Grant date weighted average exercise price, granted (in USD per share)	1.88	2.91
Grant date weighted average exercise price, exercised (in USD per share)		2.59
Grant date weighted average exercise price, forfeited (in USD per share)	2.58	3.05
Grant date weighted-average exercise price, ending balance (in USD per share)	2.78	2.86	$ 2.78	$ 2.85
Grant date weighted average exercise price, exercisable (in USD per share)	$ 2.80	$ 2.86
Weighted- Average Remaining Contractual Life (in Years)
Weighted average remaining contractual life (years), beginning balance	1 year 10 months 9 days	2 years 1 month 2 days	2 years 5 months 8 days	3 years 2 months 4 days
Weighted average remaining contractual life (years), granted	7 years	7 years
Weighted average remaining contractual life (years), ending balance	1 year 10 months 9 days	2 years 1 month 2 days	2 years 5 months 8 days	3 years 2 months 4 days
Weighted average remaining contractual life (years), exercisable	1 year 8 months 8 days	1 year 11 months 19 days
Intrinsic Value
Intrinsic value, outstanding beginning balance	$ 0	$ 42	$ 27	$ 0
Intrinsic value, grants in period	0	0
Intrinsic value, forfeitures in period	0	0
Intrinsic value, outstanding ending balance	0	42	$ 27	$ 0
Intrinsic value, exercisable end of period	$ 0	$ 0

GKCE Acquisition - Narrative (D

GKCE Acquisition - Narrative (Details) - USD ($) $ in Thousands	Jun. 12, 2020	Sep. 30, 2020	Jun. 30, 2020	Sep. 30, 2020	Sep. 30, 2019
Business Acquisition [Line Items]
First working capital payment				$ 43	$ 0
GKCE acquisition
Business Acquisition [Line Items]
Asset acquisition, percentage of shares acquired	98.00%	99.30%		99.30%
Asset acquisition, percentage of shares remaining	0.70%
Fair value of noncontrolling interest	$ 58
Percentage of outstanding shares	100.00%
Consideration allocated to assets acquired and liabilities assumed	$ 2,869
Base purchase consideration	2,000
Payments for asset acquisitions	575
Asset acquisition, transaction costs	1,425
First working capital payment	515
Additional consideration transferred	354
Goodwill	1,265
Tangible and intangible assets acquired	801
Acquisition related costs		$ 69	$ 93
GKCE acquisition | Purchased intangible assets
Business Acquisition [Line Items]
Purchased intangible assets	$ 78

GKCE Acquisition - Schedule of

GKCE Acquisition - Schedule of Purchase Price Consideration (Details) - USD ($) $ in Thousands	Jun. 12, 2020	Sep. 30, 2020	Sep. 30, 2019
Business Acquisition [Line Items]
First working capital payment		$ (43)	$ 0
GKCE acquisition
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 723
Goodwill	1,265
Total assets acquired	3,347
Accounts payable	(193)
Income taxes payable	(136)
Deferred income taxes	66
Employee compensation and benefits	83
Total liabilities assumed	(478)
Consideration allocated to assets acquired and liabilities assumed	2,869
First working capital payment	(515)
Estimated subsequent working capital payment	(354)
Base purchase consideration	2,000
GKCE acquisition | Building
Business Acquisition [Line Items]
Cash and cash equivalents	432
Accounts receivable	827
Prepaid expense and other	22
Property, plant and equipment, additions	404
GKCE acquisition | Medical equipment
Business Acquisition [Line Items]
Property, plant and equipment, additions	319
GKCE acquisition | Purchased intangible assets
Business Acquisition [Line Items]
Purchased intangible assets	$ 78

GKCE Acquisition - Schedule o_2

GKCE Acquisition - Schedule of Tangible Assets Acquired as Part of Business Combination (Details) - GKCE acquisition $ in Thousands	Jun. 12, 2020USD ($)
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 723
Building
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 404
Useful life	20 years
Medical equipment
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 302
Useful life	2 years
Other fixed assets
Business Acquisition [Line Items]
Property, plant and equipment, additions	$ 17
Useful life	2 years