American Shared Hospital Services (AMS) 10-Q 13 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2019	May 06, 2019
Document and Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Entity Registrant Name	AMERICAN SHARED HOSPITAL SERVICES
Entity Central Index Key	0000744825
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Trading Symbol	AMS
Entity Common Stock, Shares Outstanding		5,714,000
Entity Emerging Growth Company	false
Entity Small Business	true

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($)	Mar. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 2,049,000	$ 1,442,000
Restricted cash	350,000	350,000
Accounts receivable, net of allowance for doubtful accounts of $100,000 at March 31, 2019 and $100,000 at December 31, 2018	5,918,000	5,502,000
Other receivables insurance proceeds	0	1,137,000
Other receivables	300,000	239,000
Prepaid expenses and other current assets	1,021,000	1,276,000
Total current assets	9,638,000	9,946,000
Property and equipment:
Medical equipment and facilities	90,214,000	94,031,000
Office equipment	573,000	589,000
Deposits and construction in progress	4,276,000	6,082,000
Property and equipment Gross	95,063,000	100,702,000
Accumulated depreciation and amortization	(49,998,000)	(54,008,000)
Net property and equipment	45,065,000	46,694,000
Right of use assets	1,300,000	0
Other assets	854,000	862,000
Total assets	56,857,000	57,502,000
Current liabilities:
Accounts payable	446,000	435,000
Employee compensation and benefits	246,000	207,000
Other accrued liabilities	1,343,000	1,329,000
Other accrued liabilities insurance payable	0	977,000
Current portion of lease liabilities	262,000	0
Current portion of long-term debt	2,044,000	2,119,000
Current portion of obligations under capital leases	4,446,000	4,407,000
Total current liabilities	8,787,000	9,474,000
Long-term lease liabilities, less current portion	1,038,000	0
Long-term debt, less current portion	2,893,000	3,332,000
Long-term capital leases, less current portion	9,223,000	10,308,000
Deferred revenue, less current portion	355,000	382,000
Deferred income taxes	3,082,000	2,958,000
Shareholders' equity:
Common stock, no par value (10,000,000 authorized; 5,714,000 shares issued and outstanding at March 31, 2019 and at December 31, 2018)	10,711,000	10,711,000
Additional paid-in capital	6,550,000	6,495,000
Retained earnings	8,166,000	7,896,000
Total equity-American Shared Hospital Services	25,427,000	25,102,000
Non-controlling interest in subsidiary	6,052,000	5,946,000
Total shareholders' equity	31,479,000	31,048,000
Total liabilities and shareholders' equity	$ 56,857,000	$ 57,502,000

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS [Parenthetical] - USD ($)	Mar. 31, 2019	Dec. 31, 2018
Allowance for doubtful accounts (in dollars)	$ 100,000	$ 100,000
Common stock, shares authorized	10,000,000	10,000,000
Common stock, shares issued	5,714,000	5,714,000
Common stock, shares outstanding	5,714,000	5,714,000

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Rental income from medical services	$ 5,321,000	$ 5,305,000
Costs of revenue:
Maintenance and supplies	668,000	626,000
Depreciation and amortization	1,894,000	1,657,000
Other direct operating costs	822,000	816,000
Costs of revenue	3,384,000	3,099,000
Gross Margin	1,937,000	2,206,000
Selling and administrative expense	1,055,000	986,000
Interest expense	367,000	425,000
Operating income	515,000	795,000
Interest and other income	4,000	5,000
Income before income taxes	519,000	800,000
Income tax expense	124,000	150,000
Net income	395,000	650,000
Less: Net income attributable to non-controlling interest	(125,000)	(260,000)
Net income attributable to American Shared Hospital Services	$ 270,000	$ 390,000
Net income per share:
Earnings per common share - basic	$ 0.05	$ 0.07
Earnings per common share - diluted	$ 0.05	$ 0.07

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENT OF SHAREHOLDERS' EQUITY - USD ($)	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Sub-Total ASHS [Member]	Non-controlling Interest [Member]
Balances at Dec. 31, 2017	$ 29,885,000	$ 10,711,000	$ 6,272,000	$ 6,873,000	$ 23,856,000	$ 6,029,000
Balances (in shares) at Dec. 31, 2017		5,710,000
Stock-based compensation expense	55,000	$ 0	55,000	0	55,000	0
Stock-based compensation expense (in shares)		0
Net income	650,000	$ 0	0	390,000	390,000	260,000
Balances at Mar. 31, 2018	30,590,000	$ 10,711,000	6,327,000	7,263,000	24,301,000	6,289,000
Balances (in shares) at Mar. 31, 2018		5,710,000
Balances at Dec. 31, 2018	31,048,000	$ 10,711,000	6,495,000	7,896,000	25,102,000	5,946,000
Balances (in shares) at Dec. 31, 2018		5,714,000
Stock-based compensation expense	55,000	$ 0	55,000	0	55,000	0
Stock-based compensation expense (in shares)		0
Cash distributions to non-controlling interests	(19,000)	$ 0	0	0	0	(19,000)
Net income	395,000	0	0	270,000	270,000	125,000
Balances at Mar. 31, 2019	$ 31,479,000	$ 10,711,000	$ 6,550,000	$ 8,166,000	$ 25,427,000	$ 6,052,000
Balances (in shares) at Mar. 31, 2019		5,714,000

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Operating activities:
Net income	$ 395,000	$ 650,000
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	1,910,000	1,677,000
Deferred income tax	124,000	118,000
Stock-based compensation expense	55,000	55,000
Net accrued interest on lease financing	2,000	0
Changes in operating assets and liabilities:
Receivables	(477,000)	(575,000)
Prepaid expenses and other assets	254,000	143,000
Customer deposits/deferred revenue	(15,000)	(40,000)
Accounts payable and accrued liabilities	52,000	589,000
Net cash from operating activities	2,300,000	2,617,000
Investing activities:
Payment for purchase of property and equipment	(272,000)	(497,000)
Proceeds from insurance	160,000	0
Net cash used in investing activities	(112,000)	(497,000)
Financing activities:
Principal payments on long-term debt	(516,000)	(484,000)
Principal payments on capital leases	(1,046,000)	(1,037,000)
Distributions to non-controlling interests	(19,000)	0
Net cash used in financing activities	(1,581,000)	(1,521,000)
Net change in cash, cash equivalents, and restricted cash	607,000	599,000
Cash, cash equivalents, and restricted cash at beginning of period	1,792,000	2,502,000
Cash, cash equivalents, and restricted cash at end of period	2,399,000	3,101,000
Supplemental cash flow disclosure:
Interest	367,000	425,000
Income taxes	67,000	12,000
Schedule of non-cash investing and financing activities
Right of use assets and lease liabilities	1,300,000	0
Interest capitalized to property and equipment	$ 27,000	$ 28,000

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Note 1. Basis of Presentation In the opinion of management, the accompanying unaudited condensed consolidated financial statements contain all adjustments necessary to present fairly American Shared Hospital Services’ consolidated financial position as of March 31, 2019 and the results of its operations for the three-month periods ended March 31, 2019 and 2018, which results are not necessarily indicative of results on an annualized basis. Consolidated balance sheet amounts as of December 31, 2018 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, 2018 included in American Shared Hospital Services’ Annual Report on Form 10-K filed with the Securities and Exchange Commission. These 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”); GKF is the majority owner of the subsidiaries Albuquerque GK Equipment, LLC (“AGKE”) and Jacksonville GK Equipment, LLC (“JGKE”). 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 March 31, 2019, GKF provided 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 a single-unit Gamma Knife facility in Lima, Peru. 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 also directly provides radiation therapy and related equipment, including Intensity Modulated Radiation Therapy, Image Guided Radiation Therapy (“IGRT”) and a CT Simulator to the radiation therapy department at an existing Gamma Knife site in Massachusetts. The Company formed the subsidiaries GKPeru for the purposes of expanding its business internationally; Orlando and LBE to provide proton beam therapy 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. The Company continues to develop its design and business model for The Operating Room for the 21st Century SM 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 and Adopted Based on the guidance provided in accordance with Accounting Standards Codification (“ASC”) 280 Segment Reporting (“ASC 280”), the Company has analyzed its subsidiaries which are all in the business of leasing radiosurgery and radiation therapy equipment to healthcare providers, and concluded there is one reportable segment, Medical Services Revenue. The Company provides Gamma Knife, PBRT, and IGRT equipment to sixteen hospitals in the United States and owns and operates a single-unit facility in Lima, Peru as of March 31, 2019. These seventeen locations operate under different subsidiaries of the Company but offer the same services: radiosurgery and radiation therapy. The operating results of the subsidiaries are reviewed by the Company’s Chief Executive Officer and Chief Financial Officer, who are also deemed the Company’s Chief Operating Decision Makers (“CODMs”) and this is done in conjunction with all of the subsidiaries and locations. In February 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2016-02 Leases (“ASU 2016-02”) which requires lessees to recognize, for all leases, at the commencement date, a lease liability, and a right-of-use asset. Under the new guidance, lessor classification criteria for direct financing and sales-type leases is modified. In July 2018, the FASB issued ASU No. 2018-10 Leases (Topic 842) Codification Improvements to Topic 842 , and ASU No. 2018-11 Leases (Topic 842) Targeted Improvements (“ASU 2018-11”), in December 2018 the FASB issued ASU No. 2018-20 Leases (Topic 842) Narrow-Scope Improvements , and in February 2019 the FASB issued ASU No. 2019-01 Leases (Topic 842) Codification Improvements . ASU 2018-11 provides a new transition method in which an entity can initially apply the new lease standards at the adoption date and recognize a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption. This standard is effective for annual periods beginning after December 15, 2018. The Company performed an analysis to determine if its revenue agreements with customers fall under the scope of ASU 2016-02 or ASU 2014-09, Revenue from Contracts with Customers (Topic 606) and concluded that, other than with respect to the Company’s stand-alone facility in Lima, Peru, ASU 2016-02 applied. The Company adopted ASU 2016-02 and related ASUs as of January 1, 2019 using the modified retrospective transition method. The Company elected to initially apply ASU 2016 and related ASUs beginning January 1, 2019 and elected to use the package of practical expedients upon adoption. The provisions of the package of practical expedients allowed the Company to not reassess whether any expired or existing contracts are or contain leases, the lease classification for expired or existing contracts, and the Company need not reassess the initial direct costs for any existing leases. The Company also used the hindsight expedient upon adoption which allowed the Company to examine its history when assessing lease term and whether it will exercise renewal options for certain contracts. The Company recognized lease liabilities and right-of-use assets of approximately $1,362,000 for its operating leases at January 1, 2019, with no initial material impact to its consolidated statements of operations. In June 2016, the FASB issued ASU No. 2016-13 Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”), which requires measurement and recognition of expected credit losses for financial assets held. The new guidance is effective for fiscal periods beginning after December 15, 2018. The Company adopted ASU 2016-13 as of January 1, 2019 and there was no significant impact on its consolidated financial statements and related disclosures as a result. In July 2018, the FASB issued ASU No. 2018-09, Codification Improvements (“ASU 2018-09”). This standard does not prescribe any new accounting guidance, but instead makes minor improvements and clarifications of several different FASB Accounting Standards Codification areas based on comments and suggestions made by various stakeholders. Certain updates are applicable immediately while others provide for a transition period to adopt as part of the next fiscal year beginning after December 15, 2018. The Company adopted ASU 2018-09 as of January 1, 2019 and there was no significant impact on its consolidated financial statements as a result. Accounting Pronouncements Issued and Not Yet 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 2016-01. 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 does not expect ASU 2018-03 or ASU 2018-13 to have a significant impact on its consolidated financial statements and related disclosures.

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2019
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment Disclosure [Text Block]	Note 2. Property and Equipment Property and equipment are stated at cost less accumulated depreciation. Depreciation for Gamma Knife, IGRT, 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 March 31, 2019 and December 31, 2018: March 31, December 31, 2019 2018 Medical equipment and facilities $ 90,214,000 $ 94,031,000 Office equipment 573,000 589,000 Deposits and construction in progress 2,026,000 3,832,000 Deposits towards purchase of proton beam systems 2,250,000 2,250,000 95,063,000 100,702,000 Accumulated depreciation (49,998,000 ) (54,008,000 ) Net property and equipment $ 45,065,000 $ 46,694,000 As of March 31, 2019, the Company has one idle Gamma Knife unit with a cumulative net book value of $729,000. There are currently no commitments to place into service or trade in this unit during 2019.

Long-Term Debt Financing

Long-Term Debt Financing	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Long-term Debt [Text Block]	Note 3. Long-Term Debt Financing Long-term debt consists of seven notes with three financing companies collateralized by the Gamma Knife equipment, the individual customer contracts, and related accounts receivable at March 31, 2019. As of March 31, 2019, long-term debt on the Condensed Consolidated Balance Sheets was $4,937,000. See disclosure of future payments below under the heading “Commitments”.

Capital Lease Financing

Capital Lease Financing	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Debt and Capital Leases Disclosures [Text Block]	Note 4. Capital Lease Financing Capital lease financing consists of ten leases with three financing companies, collateralized by Gamma Knife and PBRT equipment, the individual customer contracts, and related accounts receivable at March 31, 2019. As of March 31, 2019, obligations under capital leases on the Condensed Consolidated Balance Sheets were $13,669,000. See disclosure of future payments below under the heading “Commitments”.

Leases

Leases	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Lessor, Operating Leases [Text Block]	Note 5. 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, PBRT, and IGRT 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 (see further discussion at Note 2). 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 receivable. 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, so the Company determined its incremental borrowing rate of approximately 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 5 years, some of which include options to renew or extend the lease. As of March 31, 2019, operating ROU assets and liabilities were $1,300,000. The following table summarizes maturities of lessee operating lease ROU assets and liabilities as of March 31, 2019: Year ending December 31, Operating Leases 2019 (excluding the three-months ended March 31, 2019) $ 250,000 2020 340,000 2021 347,000 2022 331,000 2023 214,000 Thereafter 6,000 Total lease payments 1,488,000 Less imputed interest (188,000 ) Total $ 1,300,000

Per Share Amounts

Per Share Amounts	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Earnings Per Share [Text Block]	Note 6. Per Share Amounts Per share information has been computed based on the weighted average number of common shares and dilutive common share equivalents outstanding. The computation for the three-month periods ended March 31, 2019 and 2018 excluded approximately 547,000 and 549,000, respectively, of the Company’s stock options because the exercise price of the options was higher than the average market price during those periods. Based on the guidance provided in accordance with ASC 260 Earnings Per Share (“ASC 260”), the weighted average common shares for basic earnings per share, for the three-month periods ended March 31, 2019 and 2018, excluded the weighted average impact of the unvested performance share awards, discussed below. These awards are legally outstanding but are not deemed participating securities and therefore are excluded from the calculation of basic earnings per share. The unvested shares are also excluded from the denominator for diluted earnings per share because they are considered contingent shares not deemed probable as of March 31, 2019. The following table sets forth the computation of basic and diluted earnings per share for the three-month periods ended March 31, 2019 and 2018: Three Months ended March 31, 2019 2018 Net income attributable to American Shared Hospital Services $ 270,000 $ 390,000 Weighted average common shares for basic earnings per share 5,853,000 5,818,000 Diluted effect of stock options and restricted stock 33,000 37,000 Weighted average common shares for diluted earnings per share 5,886,000 5,855,000 Basic earnings per share $ 0.05 $ 0.07 Diluted earnings per share $ 0.05 $ 0.07

Stock-based Compensation

Stock-based Compensation	3 Months Ended
	Mar. 31, 2019
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Disclosure of Compensation Related Costs, Share-based Payments [Text Block]	Note 7. 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. The Plan is a successor to the Company’s previous plans, and any shares awarded and outstanding under those plans were transferred to the Plan. No further grants or share issuances will be made under the previous plans. On June 27, 2017, 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, 2020. 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 amortized 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 units in the amount of $55,000 and $55,000 is reflected in net income for the three-month periods ended March 31, 2019 and 2018, respectively. At March 31, 2019, there was approximately $114,000 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 five 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 expire 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, 2017, 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. As of March 31, 2019, it is not probable that any of the remaining required metrics for vesting will be achieved. The unrecognized stock-based compensation expense for these awards was approximately $434,000 and unvested awards were approximately 129,000 as of March 31, 2019. If and when the Company determines that the remaining performance metrics’ achievement becomes probable, the Company will record a cumulative catch-up stock-based compensation amount and the remaining unrecognized amount will be recorded over the remaining requisite service period of the awards. The following table summarizes stock option activity for the three-month period ended March 31, 2019: Stock Options Grant Date Weighted- Average Exercise Price Weighted- Average Remaining Contractual Life (in Years) Intrinsic Value Outstanding at January 1, 2019 613,000 $ 2.85 3.14 $ - Outstanding at March 31, 2019 613,000 $ 2.85 2.43 $ 34,000 Exercisable at March 31, 2019 489,000 $ 2.87 2.31 $ -

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Income Tax Disclosure [Text Block]	Note 8. 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-month period ended March 31, 2019 by applying the actual effective tax rates to income or (loss) reported within the condensed consolidated financial statements through those periods.

Property and Equipment (Tables)

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2019
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment [Table Text Block]	The following table summarizes property and equipment as of March 31, 2019 and December 31, 2018: March 31, December 31, 2019 2018 Medical equipment and facilities $ 90,214,000 $ 94,031,000 Office equipment 573,000 589,000 Deposits and construction in progress 2,026,000 3,832,000 Deposits towards purchase of proton beam systems 2,250,000 2,250,000 95,063,000 100,702,000 Accumulated depreciation (49,998,000 ) (54,008,000 ) Net property and equipment $ 45,065,000 $ 46,694,000

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Lessee, Operating Lease, Liability, Maturity [Table Text Block]	The following table summarizes maturities of lessee operating lease ROU assets and liabilities as of March 31, 2019: Year ending December 31, Operating Leases 2019 (excluding the three-months ended March 31, 2019) $ 250,000 2020 340,000 2021 347,000 2022 331,000 2023 214,000 Thereafter 6,000 Total lease payments 1,488,000 Less imputed interest (188,000 ) Total $ 1,300,000

Per Share Amounts (Tables)

Per Share Amounts (Tables)	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	The following table sets forth the computation of basic and diluted earnings per share for the three-month periods ended March 31, 2019 and 2018: Three Months ended March 31, 2019 2018 Net income attributable to American Shared Hospital Services $ 270,000 $ 390,000 Weighted average common shares for basic earnings per share 5,853,000 5,818,000 Diluted effect of stock options and restricted stock 33,000 37,000 Weighted average common shares for diluted earnings per share 5,886,000 5,855,000 Basic earnings per share $ 0.05 $ 0.07 Diluted earnings per share $ 0.05 $ 0.07

Stock-based Compensation (Table

Stock-based Compensation (Tables)	3 Months Ended
	Mar. 31, 2019
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Share-based Compensation, Stock Options, Activity [Table Text Block]	The following table summarizes stock option activity for the three-month period ended March 31, 2019: Stock Options Grant Date Weighted- Average Exercise Price Weighted- Average Remaining Contractual Life (in Years) Intrinsic Value Outstanding at January 1, 2019 613,000 $ 2.85 3.14 $ - Outstanding at March 31, 2019 613,000 $ 2.85 2.43 $ 34,000 Exercisable at March 31, 2019 489,000 $ 2.87 2.31 $ -

Basis of Presentation (Details

Basis of Presentation (Details Textual) - USD ($)	Mar. 31, 2019	Jan. 01, 2019	Dec. 31, 2018
Operating Lease, Right-of-Use Asset	$ 1,300,000		$ 0
Accounting Standards Update 2016-02 [Member]
Operating Lease, Right-of-Use Asset		$ 1,362,000
Operating Lease, Liability		$ 1,362,000
OR21 LLC [Member]
Equity Method Investment, Ownership Percentage	50.00%
Architectural Design Company [Member]
Equity Method Investment, Ownership Percentage	50.00%

Property and Equipment (Details

Property and Equipment (Details) - USD ($)	Mar. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	$ 95,063,000	$ 100,702,000
Accumulated depreciation	(49,998,000)	(54,008,000)
Net property and equipment	45,065,000	46,694,000
Medical equipment and facilities [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	90,214,000	94,031,000
Office equipment [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	573,000	589,000
Deposits and construction in progress [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	2,026,000	3,832,000
Deposits towards purchase of proton beam systems [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Gross	$ 2,250,000	$ 2,250,000

Property and Equipment (Detai_2

Property and Equipment (Details Textual) - USD ($)	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Net	$ 45,065,000	$ 46,694,000
Gamma Knife [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Net	$ 729,000
Medical Equipment and Facilities [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	3 years
Medical Equipment and Facilities [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	10 years
PBRT Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	20 years

Long-Term Debt Financing (Detai

Long-Term Debt Financing (Details Textual)	Mar. 31, 2019USD ($)
Debt Instrument [Line Items]
Long-term Debt	$ 4,937,000

Capital Lease Financing (Detail

Capital Lease Financing (Details Textual)	Mar. 31, 2019USD ($)
Capital Lease Obligations [Line Items]
Capital Lease Obligations	$ 13,669,000

Leases (Details)

Leases (Details)	Mar. 31, 2019USD ($)
Capital Lease Obligations [Line Items]
2019	$ 250,000
2020	340,000
2021	347,000
2022	331,000
2023	214,000
Thereafter	6,000
Total capital lease payments	1,488,000
Less imputed interest	(188,000)
Gross Minimum Lease Payments	$ 1,300,000

Leases (Details Textual)

Leases (Details Textual) - USD ($)	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Operating Leased Assets [Line Items]
Operating Lease, Right-of-Use Asset	$ 1,300,000	$ 0
Lessee, Operating Lease, Discount Rate	6.00%
Minimum [Member]
Operating Leased Assets [Line Items]
Operating Lease Remaining Lease Term	3 years
Maximum [Member]
Operating Leased Assets [Line Items]
Operating Lease Remaining Lease Term	5 years

Per Share Amounts (Details)

Per Share Amounts (Details) - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Schedule Of Earnings Per Share Basic And Diluted [Line Items]
Net income attributable to American Shared Hospital Services	$ 270,000	$ 390,000
Weighted average common shares for basic earnings per share	5,853,000	5,818,000
Diluted effect of stock options and restricted stock	33,000	37,000
Weighted average common shares for diluted earnings per share	5,886,000	5,855,000
Basic earnings per share	$ 0.05	$ 0.07
Diluted earnings per share	$ 0.05	$ 0.07

Per Share Amounts (Details Text

Per Share Amounts (Details Textual) - shares	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Warrant [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	547,000	549,000

Stock-based Compensation (Detai

Stock-based Compensation (Details) - Employee Stock Option [Member] - USD ($)	3 Months Ended	12 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Shareholders Equity [Line Items]
Stock Options, Outstanding Beginning balance	613,000
Stock Options, Outstanding Ending balance	613,000
Stock Options, Exercisable	489,000
Grant Date Weighted-Average Exercise Price, Beginning balance	$ 2.85
Grant Date Weighted-Average Exercise Price, Ending balance	2.85
Grant Date Weighted Average Exercise Price, Exercisable	$ 2.87
Weighted Average Remaining Contractual Life (Years), Balance	2 years 5 months 4 days	3 years 1 month 20 days
Weighted Average Remaining Contractual Life (Years), Exercisable	2 years 3 months 21 days
Intrinsic Value, Outstanding	$ 34,000	$ 0
Intrinsic Value, Exercisable at March 31, 2019	$ 0

Stock-based Compensation (Det_2

Stock-based Compensation (Details Textual) - USD ($)	Jan. 04, 2017	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2017	Jun. 30, 2010
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Allocated Share-based Compensation Expense		$ 55,000	$ 55,000	$ 108,000
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized		434,000
Incentive Compensation Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance					1,630,000
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized		$ 114,000
Performance Share Award Agreement [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	161,766
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number		129,000