Document And Entity Information
Document And Entity Information - shares | 3 Months Ended | |
Mar. 31, 2023 | May 09, 2023 | |
Document Information [Line Items] | ||
Entity Central Index Key | 0000744825 | |
Entity Registrant Name | AMERICAN SHARED HOSPITAL SERVICES | |
Amendment Flag | false | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Period Focus | Q1 | |
Document Fiscal Year Focus | 2023 | |
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Mar. 31, 2023 | |
Document Transition Report | false | |
Entity File Number | 001-08789 | |
Entity Incorporation, State or Country Code | CA | |
Entity Tax Identification Number | 94-2918118 | |
Entity Address, Address Line One | 601 Montgomery Street | |
Entity Address, City or Town | San Francisco | |
Entity Address, State or Province | CA | |
Entity Address, Postal Zip Code | 94111-2619 | |
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 | NYSE | |
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 | 6,214,000 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) | Mar. 31, 2023 | Dec. 31, 2022 |
Current assets: | ||
Cash and cash equivalents | $ 13,083,000 | $ 12,335,000 |
Restricted cash | 118,000 | 118,000 |
Accounts receivable, net of allowance for doubtful accounts of $100,000 at March 31, 2023 and at December 31, 2022 | 4,369,000 | 3,801,000 |
Other receivables | 404,000 | 327,000 |
Prepaid maintenance | 816,000 | 1,245,000 |
Prepaid expenses and other current assets | 781,000 | 897,000 |
Total current assets | 19,571,000 | 18,723,000 |
Property and equipment, net | 22,296,000 | 23,467,000 |
Land | 19,000 | 19,000 |
Goodwill | 1,265,000 | 1,265,000 |
Right of use assets, net | 232,000 | 317,000 |
Intangible asset | 78,000 | 78,000 |
Other assets | 86,000 | 87,000 |
Total assets | 43,547,000 | 43,956,000 |
Current liabilities: | ||
Accounts payable | 254,000 | 230,000 |
Employee compensation and benefits | 526,000 | 735,000 |
Other accrued liabilities | 1,478,000 | 1,544,000 |
Asset retirement obligations, related party | 360,000 | 360,000 |
Income taxes payable | 255,000 | 255,000 |
Current portion deferred revenue | 473,000 | 0 |
Current portion of lease liabilities | 215,000 | 292,000 |
Current portion of long-term debt, net | 1,262,000 | 1,262,000 |
Total current liabilities | 5,254,000 | 5,175,000 |
Long-term lease liabilities, less current portion | 36,000 | 59,000 |
Long-term debt, net, less current portion | 11,493,000 | 12,205,000 |
Deferred revenue, less current portion | 53,000 | 70,000 |
Deferred income taxes | 890,000 | 822,000 |
Total liabilities | 17,726,000 | 18,331,000 |
Commitments (see Note 9) | ||
Shareholders' equity: | ||
Common stock, no par value (10,000,000 authorized; Issued and outstanding shares - 6,184,000 at March 31, 2023 and at December 31, 2022) | 10,763,000 | 10,763,000 |
Additional paid-in capital | 7,939,000 | 7,843,000 |
Retained earnings | 3,207,000 | 3,019,000 |
Total equity-American Shared Hospital Services | 21,909,000 | 21,625,000 |
Non-controlling interests in subsidiaries | 3,912,000 | 4,000,000 |
Total shareholders' equity | 25,821,000 | 25,625,000 |
Total liabilities and shareholders' equity | 43,547,000 | 43,956,000 |
Related Party [Member] | ||
Current liabilities: | ||
Related party liabilities | $ 431,000 | $ 497,000 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - USD ($) $ / shares in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Allowance for doubtful accounts | $ 100,000 | $ 100,000 |
Common stock, no par value (in dollars per share) | $ 0 | $ 0 |
Common stock, shares authorized (in shares) | 10,000,000 | 10,000,000 |
Common stock, shares issued (in shares) | 6,184,000 | 6,184,000 |
Common stock, shares outstanding (in shares) | 6,184,000 | 6,184,000 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Income (Unaudited) - USD ($) | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Revenues | $ 4,925,000 | $ 4,847,000 |
Costs of revenue: | ||
Maintenance and supplies | 486,000 | 440,000 |
Depreciation and amortization | 1,357,000 | 1,187,000 |
Other direct operating costs | 879,000 | 884,000 |
Other direct operating costs, related party | 295,000 | 269,000 |
Cost of Revenue | 3,017,000 | 2,780,000 |
Gross margin | 1,908,000 | 2,067,000 |
Selling and administrative expense | 1,539,000 | 1,319,000 |
Interest expense | 271,000 | 148,000 |
Operating income | 98,000 | 600,000 |
Interest and other income | 70,000 | 0 |
Income before income taxes | 168,000 | 600,000 |
Income tax expense | 68,000 | 206,000 |
Net income | 100,000 | 394,000 |
Less: Net loss (income) attributable to non-controlling interests | 88,000 | (125,000) |
Net income attributable to American Shared Hospital Services | $ 188,000 | $ 269,000 |
Net income per share: | ||
Income per common share - basic (in dollars per share) | $ 0.03 | $ 0.04 |
Income per common share - diluted (in dollars per share) | $ 0.03 | $ 0.04 |
Weighted average common shares for basic earnings per share (in shares) | 6,306,000 | 6,201,000 |
Weighted average common shares for diluted earnings per share (in shares) | 6,472,000 | 6,299,000 |
Rental Income from Medical Services [Member] | ||
Revenues | $ 4,229,000 | $ 4,141,000 |
Patient Income [Member] | ||
Revenues | $ 696,000 | $ 706,000 |
Condensed Consolidated Statem_2
Condensed Consolidated Statement of Shareholders' Equity (Unaudited) - USD ($) | Restricted Stock [Member] Common Stock [Member] | Restricted Stock [Member] Additional Paid-in Capital [Member] | Restricted Stock [Member] Retained Earnings [Member] | Restricted Stock [Member] Parent [Member] | Restricted Stock [Member] Noncontrolling Interest [Member] | Restricted Stock [Member] | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | Parent [Member] | Noncontrolling Interest [Member] | Total |
Balances (in shares) at Dec. 31, 2021 | 6,049,000 | |||||||||||
Balances at Dec. 31, 2021 | $ 10,758,000 | $ 7,444,000 | $ 1,691,000 | $ 19,893,000 | $ 4,346,000 | $ 24,239,000 | ||||||
Stock-based compensation expense (in shares) | 0 | |||||||||||
Stock-based compensation expense | $ 0 | 87,000 | 0 | 87,000 | 0 | 87,000 | ||||||
Issuance of restricted stock awards (in shares) | 30,000 | |||||||||||
Issuance of restricted stock awards | $ 0 | $ 0 | $ 0 | $ 0 | $ 0 | $ 0 | ||||||
Net income | $ 0 | 0 | 269,000 | 269,000 | 125,000 | 394,000 | ||||||
Balances (in shares) at Mar. 31, 2022 | 6,079,000 | |||||||||||
Balances at Mar. 31, 2022 | $ 10,758,000 | 7,531,000 | 1,960,000 | 20,249,000 | 4,471,000 | $ 24,720,000 | ||||||
Balances (in shares) at Dec. 31, 2022 | 6,184,000 | 6,184,000 | ||||||||||
Balances at Dec. 31, 2022 | $ 10,763,000 | 7,843,000 | 3,019,000 | 21,625,000 | 4,000,000 | $ 25,625,000 | ||||||
Stock-based compensation expense (in shares) | 0 | |||||||||||
Stock-based compensation expense | $ 0 | 96,000 | 0 | 96,000 | 0 | 96,000 | ||||||
Net income | $ 0 | 0 | 188,000 | 188,000 | (88,000) | $ 100,000 | ||||||
Balances (in shares) at Mar. 31, 2023 | 6,184,000 | 6,184,000 | ||||||||||
Balances at Mar. 31, 2023 | $ 10,763,000 | $ 7,939,000 | $ 3,207,000 | $ 21,909,000 | $ 3,912,000 | $ 25,821,000 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Operating activities: | ||
Net income | $ 100,000 | $ 394,000 |
Adjustments to reconcile net income to net cash from operating activities: | ||
Depreciation, amortization, and other | 1,367,000 | 1,212,000 |
Accretion of debt issuance costs | 18,000 | 18,000 |
Non cash lease expense | 85,000 | 83,000 |
Deferred income taxes | 68,000 | 123,000 |
Stock-based compensation expense | 96,000 | 87,000 |
Interest expense associated with lease liabilities | 3,000 | 9,000 |
Changes in operating assets and liabilities: | ||
Receivables | (634,000) | (575,000) |
Prepaid expenses and other assets | 548,000 | 567,000 |
Asset retirement obligations, related party | 0 | (457,000) |
Related party liabilities | (66,000) | (805,000) |
Accounts payable, accrued liabilities, and deferred revenue | 279,000 | (297,000) |
Lease liabilities | (103,000) | (100,000) |
Net cash provided by operating activities | 1,761,000 | 259,000 |
Investing activities: | ||
Payment for purchase of property and equipment | (209,000) | (66,000) |
Net cash used in investing activities | (209,000) | (66,000) |
Financing activities: | ||
Principal payments on long-term debt | (730,000) | (55,000) |
Principal payments on short-term financing | (74,000) | 0 |
Net cash used in financing activities | (804,000) | (55,000) |
Net change in cash, cash equivalents, and restricted cash | 748,000 | 138,000 |
Cash, cash equivalents, and restricted cash at beginning of period | 12,453,000 | 8,263,000 |
Cash, cash equivalents, and restricted cash at end of period | 13,201,000 | 8,401,000 |
Supplemental cash flow disclosure | ||
Interest | 253,000 | 130,000 |
Income taxes | 20,000 | 55,000 |
Detail of cash, cash equivalents and restricted cash at end of period | ||
Cash and cash equivalents | 13,083,000 | 8,283,000 |
Restricted cash | 118,000 | 118,000 |
Cash, cash equivalents, and restricted cash at end of period | $ 13,201,000 | $ 8,401,000 |
Note 1 - Basis of Presentation
Note 1 - Basis of Presentation | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block] | Note 1. Basis of Presentation In the opinion of the management of American Shared Hospital Services (“ASHS”), the accompanying unaudited condensed consolidated financial statements contain all adjustments necessary for the fair presentation of ASHS consolidated financial position as of March 31, 2023 three March 31, 2023 2022 three March 31, 2023 2022 three March 31, 2023 not December 31, 2022 These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements for the year ended December 31, 2022 10 These condensed consolidated financial statements include the accounts of ASHS and its subsidiaries (the “Company”) as follows: ASHS wholly owns the subsidiaries American Shared Radiosurgery Services (“ASRS”), PBRT Orlando, LLC (“Orlando”), OR21, The Company (through ASRS) and Elekta AB (“Elekta”), 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, 2023 twelve two The Company formed the subsidiaries GKPeru and acquired GKCE 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. LBE is not two On April 27, 2022 , October 3, 2022 December 15, 2022 . The Company continues to develop its design and business model for The Operating Room for the 21st OR21, “OR21 OR21 not two All significant intercompany accounts and transactions have been eliminated in consolidation. Accounting pronouncements issued and not yet adopted - January 2021, 2021 01 848 2021 01” 2021 01 2021 01 March 12, 2020, 2021 01 may 3 Revenue recognition 842 Leases 842” 606 Revenue from Contracts with Customers 606” Rental income from medical services 842 not ten third three March 31, 2023 2022 842, Patient income 606, no 30 3 6 not not March 31, 2023 December 31, 2022 March 31, 2023 December 31, 2022 three March 31, 2023 2022 606. Business segment information 280 Segment Reporting 280” fifteen fifteen two thirteen two March 31, 2023 280 may two two For the three March 31, 2023 2022 two March 31, 2023 2022 Three Months Ended March 31, 2023 2022 Revenues Domestic $ 4,229,000 $ 4,141,000 Foreign 696,000 706,000 Total $ 4,925,000 $ 4,847,000 Net income (loss) attributable to American Shared Hospital Services Domestic $ 255,000 $ 276,000 Foreign (67,000 ) (7,000 ) Total $ 188,000 $ 269,000 Reclassification three March 31, 2022 |
Note 2 - Property and Equipment
Note 2 - Property and Equipment | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
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 units 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 between three ten January 1, 2023, one January 1, 2023, three March 31, 2023 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, 2023 December 31, 2022 March 31, December 31, 2023 2022 Medical equipment and facilities $ 73,911,000 $ 73,709,000 Office equipment 419,000 422,000 Construction in progress 95,000 106,000 74,425,000 74,237,000 Accumulated depreciation (52,129,000 ) (50,770,000 ) Net property and equipment $ 22,296,000 $ 23,467,000 Net property and equipment held outside of the United States $ 2,020,000 $ 2,201,000 |
Note 3 - Long-Term Debt Financi
Note 3 - Long-Term Debt Financing | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
Long-Term Debt [Text Block] | Note 3. Long-Term Debt Financing On April 9, 2021 five three first second third five March 31, 2023 December 31, 2022 As of December 31, 2021, no 1 3 6 12 2023. 2023. one five The Credit Agreement contains customary covenants and representations, including without limitation, a minimum fixed charge coverage ratio of 1.25 and maximum funded debt to EBITDA ratio of 3.0 to 1.0 twelve March 31, 2023 The loan entered into with United States International Development Finance Corporation (“DFC”) in connection with the acquisition of GKCE in June 2020 ( 29 March 31, 2023 March 31, 2023 December 31, 2022 December 31, 2022, three March 31, 2023. The accretion of debt issuance costs for each of the three March 31, 2023 2022 March 31, 2023 December 31, 2022 As of March 31, 2023 March 31, 2023 Year ending December 31, Principal 2023 (excluding the three-months ended March 31, 2023) $ 915,000 2024 2,094,000 2025 2,469,000 2026 7,294,000 2027 164,000 $ 12,936,000 |
Note 4 - Other Accrued Liabilit
Note 4 - Other Accrued Liabilities | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
Other Liabilities Disclosure [Text Block] | N ote 4. Other Accrued Liabilities Other accrued liabilities consist of the following as of March 31, 2023 December 31, 2022 March 31, December 31, 2023 2022 Insurance $ 363,000 $ 591,000 Professional services 174,000 92,000 Operating costs 620,000 539,000 Other 321,000 322,000 Total other accrued liabilities $ 1,478,000 $ 1,544,000 |
Note 5 - Leases
Note 5 - Leases | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
Lessee, Operating Leases [Text Block] | Note 5. Leases The Company determines if a contract is a lease at inception. Under ASC 842, 842 not 842 842 not The Company’s Gamma Knife and PBRT contracts with hospitals are classified as operating leases under ASC 842. not not On November 3, 2021, 410, August 2023. 601 1112, November 2024. The Company’s lessee operating leases are accounted for as 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 no March 31, 2023 The following table summarizes maturities of lessee operating lease liabilities as of March 31, 2023 Year ending December 31, Operating Leases 2023 (excluding the three-months ended March 31, 2023) $ 198,000 2024 59,000 Total lease payments 257,000 Less imputed interest (6,000 ) Total $ 251,000 Three Months Ended March 31, 2023 2022 Lease cost Operating lease cost $ 103,000 $ 100,000 Sublease income (50,000 ) (43,000 ) Total lease cost $ 53,000 $ 57,000 Other information Cash paid for amounts included in the measurement of lease liabilities - Operating leases $ 103,000 $ 100,000 Weighted-average remaining lease term - Operating leases in years 0.95 1.75 Weighted-average discount rate - Operating leases 5.54 % 5.78 % |
Note 6 - Per Share Amounts
Note 6 - Per Share Amounts | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
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. Based on the guidance provided in accordance with ASC 260 Earnings Per Share 260” not The computation for the three March 31, 2023 2022 y 6,000 and 50,000, respectively, of the Company’s stock options b three March 31, 2023 2022 The following table sets forth the computation of basic and diluted earnings per share for the three March 31, 2023 2022 Three Months Ended March 31, 2023 2022 Net income attributable to American Shared Hospital Services $ 188,000 $ 269,000 Weighted average common shares for basic earnings per share 6,306,000 6,201,000 Dilutive effect of stock options and restricted stock awards 166,000 98,000 Weighted average common shares for diluted earnings per share 6,472,000 6,299,000 Basic earnings per share $ 0.03 $ 0.04 Diluted earnings per share $ 0.03 $ 0.04 |
Note 7 - Stock-based Compensati
Note 7 - Stock-based Compensation | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
Share-Based Payment Arrangement [Text Block] | Note 7. Stock-based Compensation In June 2021, five February 22, 2027. No 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 amo unt of and $87,000 three March 31, 2023 2022 i three March 31, 2023 o four three March 31, 2023 The following table summarizes stock option activity for the three March 31, 2023 2022 Stock Options Grant Date Weighted- Average Exercise Price Weighted- Average Remaining Contractual Life (in Years) Intrinsic Value Outstanding at January 1, 2023 95,000 $ 2.76 4.83 $ 25,000 Granted 50,000 $ 2.93 7.00 $ - Forfeited (2,000 ) $ 3.90 - $ - Outstanding at March 31, 2023 143,000 $ 2.80 4.76 $ 26,000 Exercisable at March 31, 2023 48,000 $ 2.73 2.51 $ - Outstanding at January 1, 2022 67,000 $ 2.72 3.33 $ - Outstanding at March 31, 2022 67,000 $ 2.72 3.09 $ 4,000 Exercisable at March 31, 2022 59,000 $ 2.72 2.77 $ - |
Note 8 - Income Taxes
Note 8 - Income Taxes | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
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 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 March 31, 2023 2022 |
Note 9 - Commitments
Note 9 - Commitments | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
Commitments and Contingencies Disclosure [Text Block] | Note 9. Commitments On December 20, 2018, two second third second third not second third no December 2023. could forfeit its deposits December 31, 2020, March 31, 2023 two S250i As of March 31, 2023 four one one three one 60 one second 2023 The Company expects to upgrade the equipment in Ecuador in mid- 2023, fourth 2023. between 2023 2024. March 31, 2023 were $16,228,000. It is the Company’s intent to finance substantially all of these commitments. There can be no and a line of credit of $7,000,000 to fund these projects. On February 15, 2023 , 60 second third 2023 . On September 4, 2022, September 2022 April 2026. one one As of March 31, 2023 , the Company had commitments to service and maintain its Gamma Knife and PBRT equipment. The service commitments are carried out via contracts with Mevion, Elekta and Mobius Imaging, LLC. In addition, in April 2019, 2023 2024. two March 31, 2023 |
Note 10 - Related Party Transac
Note 10 - Related Party Transactions | 3 Months Ended |
Mar. 31, 2023 | |
Notes to Financial Statements | |
Related Party Transactions Disclosure [Text Block] | Note 10. Related Party Transactions The Company’s Gamma Knife business is operated through its 81% indirect interest in its GKF subsidiary. The remaining 19% of GKF is owned by a wholly owned U.S. subsidiary of Elekta, which is the manufacturer of the Gamma Knife. Since the Company purchases its Gamma Knife units from Elekta, there are significant related party transactions with Elekta such as equipment purchases, commitments to purchase and service equipment, and costs to maintain the equipment. The following table summarizes related party activity for the three March 31, 2023 2022 Three Months Ended March 31, 2023 2022 Equipment purchases and de-install costs $ 201,000 $ 1,232,000 Costs incurred to maintain equipment 295,000 269,000 Total related party transactions $ 496,000 $ 1,501,000 The Company also had commitments to purchase one four one March 31, 2023 Related party liabilities on the condensed consolidated balance sheets consist of the following as of March 31, 2023 December 31, 2022 March 31, December 31, 2023 2022 Accounts payable, asset retirement obligation and other accrued liabilities $ 791,000 $ 857,000 |
Significant Accounting Policies
Significant Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2023 | |
Accounting Policies [Abstract] | |
Basis of Accounting, Policy [Policy Text Block] | In the opinion of the management of American Shared Hospital Services (“ASHS”), the accompanying unaudited condensed consolidated financial statements contain all adjustments necessary for the fair presentation of ASHS consolidated financial position as of March 31, 2023 three March 31, 2023 2022 three March 31, 2023 2022 three March 31, 2023 not December 31, 2022 These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements for the year ended December 31, 2022 10 These condensed consolidated financial statements include the accounts of ASHS and its subsidiaries (the “Company”) as follows: ASHS wholly owns the subsidiaries American Shared Radiosurgery Services (“ASRS”), PBRT Orlando, LLC (“Orlando”), OR21, The Company (through ASRS) and Elekta AB (“Elekta”), 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, 2023 twelve two The Company formed the subsidiaries GKPeru and acquired GKCE 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. LBE is not two On April 27, 2022 , October 3, 2022 December 15, 2022 . The Company continues to develop its design and business model for The Operating Room for the 21st OR21, “OR21 OR21 not two All significant intercompany accounts and transactions have been eliminated in consolidation. |
New Accounting Pronouncements, Policy [Policy Text Block] | Accounting pronouncements issued and not yet adopted - January 2021, 2021 01 848 2021 01” 2021 01 2021 01 March 12, 2020, 2021 01 may 3 |
Revenue [Policy Text Block] | Revenue recognition 842 Leases 842” 606 Revenue from Contracts with Customers 606” Rental income from medical services 842 not ten third three March 31, 2023 2022 842, Patient income 606, no 30 3 6 not not March 31, 2023 December 31, 2022 March 31, 2023 December 31, 2022 three March 31, 2023 2022 606. |
Segment Reporting, Policy [Policy Text Block] | Business segment information 280 Segment Reporting 280” fifteen fifteen two thirteen two March 31, 2023 280 may two two For the three March 31, 2023 2022 two March 31, 2023 2022 Three Months Ended March 31, 2023 2022 Revenues Domestic $ 4,229,000 $ 4,141,000 Foreign 696,000 706,000 Total $ 4,925,000 $ 4,847,000 Net income (loss) attributable to American Shared Hospital Services Domestic $ 255,000 $ 276,000 Foreign (67,000 ) (7,000 ) Total $ 188,000 $ 269,000 |
Reclassification, Comparability Adjustment [Policy Text Block] | Reclassification three March 31, 2022 |
Note 1 - Basis of Presentation
Note 1 - Basis of Presentation (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Notes Tables | |
Reconciliation of Revenue from Segments to Consolidated [Table Text Block] | Three Months Ended March 31, 2023 2022 Revenues Domestic $ 4,229,000 $ 4,141,000 Foreign 696,000 706,000 Total $ 4,925,000 $ 4,847,000 Net income (loss) attributable to American Shared Hospital Services Domestic $ 255,000 $ 276,000 Foreign (67,000 ) (7,000 ) Total $ 188,000 $ 269,000 |
Note 2 - Property and Equipme_2
Note 2 - Property and Equipment (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Notes Tables | |
Property, Plant and Equipment [Table Text Block] | March 31, December 31, 2023 2022 Medical equipment and facilities $ 73,911,000 $ 73,709,000 Office equipment 419,000 422,000 Construction in progress 95,000 106,000 74,425,000 74,237,000 Accumulated depreciation (52,129,000 ) (50,770,000 ) Net property and equipment $ 22,296,000 $ 23,467,000 Net property and equipment held outside of the United States $ 2,020,000 $ 2,201,000 |
Note 3 - Long-Term Debt Finan_2
Note 3 - Long-Term Debt Financing (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Notes Tables | |
Schedule of Maturities of Long-Term Debt [Table Text Block] | Year ending December 31, Principal 2023 (excluding the three-months ended March 31, 2023) $ 915,000 2024 2,094,000 2025 2,469,000 2026 7,294,000 2027 164,000 $ 12,936,000 |
Note 4 - Other Accrued Liabil_2
Note 4 - Other Accrued Liabilities (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Notes Tables | |
Other Liabilities [Table Text Block] | March 31, December 31, 2023 2022 Insurance $ 363,000 $ 591,000 Professional services 174,000 92,000 Operating costs 620,000 539,000 Other 321,000 322,000 Total other accrued liabilities $ 1,478,000 $ 1,544,000 |
Note 5 - Leases (Tables)
Note 5 - Leases (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Notes Tables | |
Lessee, Operating Lease, Liability, to be Paid, Maturity [Table Text Block] | Year ending December 31, Operating Leases 2023 (excluding the three-months ended March 31, 2023) $ 198,000 2024 59,000 Total lease payments 257,000 Less imputed interest (6,000 ) Total $ 251,000 |
Lease, Cost [Table Text Block] | Three Months Ended March 31, 2023 2022 Lease cost Operating lease cost $ 103,000 $ 100,000 Sublease income (50,000 ) (43,000 ) Total lease cost $ 53,000 $ 57,000 Other information Cash paid for amounts included in the measurement of lease liabilities - Operating leases $ 103,000 $ 100,000 Weighted-average remaining lease term - Operating leases in years 0.95 1.75 Weighted-average discount rate - Operating leases 5.54 % 5.78 % |
Note 6 - Per Share Amounts (Tab
Note 6 - Per Share Amounts (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Notes Tables | |
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block] | Three Months Ended March 31, 2023 2022 Net income attributable to American Shared Hospital Services $ 188,000 $ 269,000 Weighted average common shares for basic earnings per share 6,306,000 6,201,000 Dilutive effect of stock options and restricted stock awards 166,000 98,000 Weighted average common shares for diluted earnings per share 6,472,000 6,299,000 Basic earnings per share $ 0.03 $ 0.04 Diluted earnings per share $ 0.03 $ 0.04 |
Note 7 - Stock-based Compensa_2
Note 7 - Stock-based Compensation (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Notes Tables | |
Share-Based Payment Arrangement, Option, Activity [Table Text Block] | Stock Options Grant Date Weighted- Average Exercise Price Weighted- Average Remaining Contractual Life (in Years) Intrinsic Value Outstanding at January 1, 2023 95,000 $ 2.76 4.83 $ 25,000 Granted 50,000 $ 2.93 7.00 $ - Forfeited (2,000 ) $ 3.90 - $ - Outstanding at March 31, 2023 143,000 $ 2.80 4.76 $ 26,000 Exercisable at March 31, 2023 48,000 $ 2.73 2.51 $ - Outstanding at January 1, 2022 67,000 $ 2.72 3.33 $ - Outstanding at March 31, 2022 67,000 $ 2.72 3.09 $ 4,000 Exercisable at March 31, 2022 59,000 $ 2.72 2.77 $ - |
Note 10 - Related Party Trans_2
Note 10 - Related Party Transactions (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Notes Tables | |
Schedule of Related Party Transactions [Table Text Block] | Three Months Ended March 31, 2023 2022 Equipment purchases and de-install costs $ 201,000 $ 1,232,000 Costs incurred to maintain equipment 295,000 269,000 Total related party transactions $ 496,000 $ 1,501,000 March 31, December 31, 2023 2022 Accounts payable, asset retirement obligation and other accrued liabilities $ 791,000 $ 857,000 |
Note 1 - Basis of Presentatio_2
Note 1 - Basis of Presentation (Details Textual) | 3 Months Ended | |||
Mar. 31, 2023 USD ($) | Mar. 31, 2022 USD ($) | Dec. 31, 2022 USD ($) | Apr. 27, 2022 | |
Number of Reportable Segments | 2 | |||
GKCE [Member] | Related Party [Member] | ||||
Accounts Receivable, after Allowance for Credit Loss | $ 764,000 | $ 862,000 | ||
Newco [Member] | ||||
Equity Method Investment, Ownership Percentage | 85% | |||
OR21, LLC [Member] | ||||
Equity Method Investment, Ownership Percentage | 50% | |||
Guadalupe [Member] | Newco [Member] | ||||
Equity Method Investment, Ownership Percentage | 15% | |||
Architectural Design Company [Member] | OR21, LLC [Member] | ||||
Equity Method Investment, Ownership Percentage | 50% | |||
Gamma Knife Center Ecuador S.A. (GKCE) [Member] | Gamma Knife Units [Member] | ||||
Number of Medical Centers | 12 | |||
Rental Income from Medical Services [Member] | ||||
Revenue from Contract with Customer, Including Assessed Tax | $ 4,229,000 | $ 4,141,000 | ||
PBRT Services [Member] | ||||
Revenue from Contract with Customer, Including Assessed Tax | 2,314,000 | 2,039,000 | ||
Patient Income [Member] | ||||
Revenue from Contract with Customer, Including Assessed Tax | $ 696,000 | $ 706,000 | ||
Gamma Knife and PBRT Equipment [Member] | ||||
Number of Medical Centers | 13 | |||
Lima, Peru and Guayaquil, Ecuador [Member] | ||||
Number of Single-unit Facilities | 2 |
Note 1 - Basis of Presentatio_3
Note 1 - Basis of Presentation - Revenues and Profit (Loss) Allocations to Reportable Segments (Details) - USD ($) | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Revenues | $ 4,925,000 | $ 4,847,000 |
Net Income (Loss) Attributable to Parent | 188,000 | 269,000 |
Domestic Segment [Member] | ||
Revenues | 4,229,000 | 4,141,000 |
Net Income (Loss) Attributable to Parent | 255,000 | 276,000 |
Foreign Segment [Member] | ||
Revenues | 696,000 | 706,000 |
Net Income (Loss) Attributable to Parent | $ (67,000) | $ (7,000) |
Note 2 - Property and Equipme_3
Note 2 - Property and Equipment (Details Textual) - USD ($) | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Net Income (Loss) Attributable to Parent | $ 188,000 | $ 269,000 |
Earnings Per Share, Diluted (in dollars per share) | $ 0.03 | $ 0.04 |
Salvage Value [Member] | ||
Net Income (Loss) Attributable to Parent | $ (50,000) | |
Earnings Per Share, Diluted (in dollars per share) | $ 0.01 | |
Medical and Office Equipment [Member] | Minimum [Member] | ||
Property, Plant and Equipment, Useful Life (Year) | 3 years | |
Medical and Office Equipment [Member] | Maximum [Member] | ||
Property, Plant and Equipment, Useful Life (Year) | 10 years | |
PBRT Equipment [Member] | ||
Property, Plant and Equipment, Useful Life (Year) | 20 years |
Note 2 - Property and Equipme_4
Note 2 - Property and Equipment - Summary of Property and Equipment (Details) - USD ($) | Mar. 31, 2023 | Dec. 31, 2022 |
Property and equipment, gross | $ 74,237,000 | |
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total | $ 74,425,000 | |
Accumulated depreciation | (52,129,000) | (50,770,000) |
Net property and equipment | 22,296,000 | 23,467,000 |
Property and equipment, net | 22,296,000 | 23,467,000 |
Non-US [Member] | ||
Net property and equipment | 2,020,000 | 2,201,000 |
Property and equipment, net | 2,020,000 | 2,201,000 |
Medical Equipment and Facilities [Member] | ||
Property and equipment, gross | 73,911,000 | 73,709,000 |
Office Equipment [Member] | ||
Property and equipment, gross | 419,000 | 422,000 |
Construction in Progress [Member] | ||
Property and equipment, gross | $ 95,000 | $ 106,000 |
Note 3 - Long-Term Debt Finan_3
Note 3 - Long-Term Debt Financing (Details Textual) | 3 Months Ended | 12 Months Ended | ||||
Apr. 09, 2021 USD ($) | Mar. 31, 2023 USD ($) | Mar. 31, 2022 USD ($) | Dec. 31, 2021 | Dec. 31, 2023 | Dec. 31, 2022 USD ($) | |
Long-Term Debt | $ 12,755,000 | |||||
Amortization of Debt Issuance Costs | 18,000 | $ 18,000 | ||||
Debt Issuance Costs, Net | 181,000 | $ 198,000 | ||||
The Credit Agreement [Member] | Fifth Third Bank, N.A. [Member] | ||||||
Debt Instrument, Term (Year) | 5 years | |||||
Line of Credit Facility, Maximum Borrowing Capacity | $ 22,000,000 | |||||
Number of Debt Instruments | 3 | |||||
Debt Instrument, Covenant, Minimum Fixed Charge Coverage Ratio | 1.25 | |||||
Debt Instrument, Covenant, Maximum Funded Debt to EDITDA Ratio | 3 | |||||
The Credit Agreement, First Loan and Second Loan Facility [Member] | Fifth Third Bank, N.A. [Member] | ||||||
Debt Instrument, Face Amount | $ 9,500,000 | |||||
Long-Term Debt | 11,949,000 | 12,624,000 | ||||
The Credit Agreement, First Loan and Second Loan Facility [Member] | Fifth Third Bank, N.A. [Member] | Forecast [Member] | ||||||
Debt Instrument, Interest Rate, Stated Percentage | 48% | |||||
The Credit Agreement, Second Loan Facility [Member] | Fifth Third Bank, N.A. [Member] | ||||||
Debt Instrument, Face Amount | $ 5,500,000 | |||||
The Credit Agreement, Third Loan Facility [Member] | Fifth Third Bank, N.A. [Member] | Revolving Credit Facility [Member] | ||||||
Debt Instrument, Term (Year) | 5 years | |||||
Line of Credit Facility, Maximum Borrowing Capacity | $ 7,000,000 | |||||
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage | 0.25% | |||||
The Credit Agreement, Third Loan Facility [Member] | Fifth Third Bank, N.A. [Member] | Revolving Credit Facility [Member] | London Interbank Offered Rate [Member] | ||||||
Debt Instrument, Basis Spread on Variable Rate | 3% | |||||
DFC Loan [Member] | ||||||
Long-Term Debt | $ 987,000 | 1,041,000 | ||||
Debt Instrument, Interest Rate, Stated Percentage | 3.67% | |||||
Debt Issuance Costs, Gross | $ 0 | $ 9,000 |
Note 3 - Long-Term Debt Finan_4
Note 3 - Long-Term Debt Financing - Long-term Debt Maturities (Details) | Mar. 31, 2023 USD ($) |
2023 (excluding the three-months ended March 31, 2023) | $ 915,000 |
2024 | 2,094,000 |
2025 | 2,469,000 |
2026 | 7,294,000 |
2027 | 164,000 |
Long-Term Debt, Gross | $ 12,936,000 |
Note 4 - Other Accrued Liabil_3
Note 4 - Other Accrued Liabilities - Other Accrued Liabilities (Details) - USD ($) | Mar. 31, 2023 | Dec. 31, 2022 |
Insurance | $ 363,000 | $ 591,000 |
Professional services | 174,000 | 92,000 |
Operating costs | 620,000 | 539,000 |
Other | 321,000 | 322,000 |
Total other accrued liabilities | $ 1,478,000 | $ 1,544,000 |
Note 5 - Leases (Details Textua
Note 5 - Leases (Details Textual) | Nov. 03, 2021 USD ($) ft² | Mar. 31, 2023 USD ($) | Dec. 31, 2022 USD ($) |
Operating Lease, Right-of-Use Asset | $ 232,000 | $ 317,000 | |
Operating Lease, Liability | $ 251,000 | ||
Minimum [Member] | |||
Lessee, Operating Lease, Discount Rate | 4% | ||
Lessee, Operating Lease, Remaining Lease Term (Year) | 1 year | ||
Maximum [Member] | |||
Lessee, Operating Lease, Discount Rate | 6% | ||
Lessee, Operating Lease, Remaining Lease Term (Year) | 2 years | ||
Sublease Office in San Francisco, California [Member] | |||
Area of Real Estate Property (Square Foot) | ft² | 3,253 | ||
Operating Lease, Monthly Expense | $ 22,011 | ||
Lessee, Operating Sublease, Monthly Income | $ 16,195 | ||
Lease Agreement for New Corporate Office [Member] | |||
Area of Real Estate Property (Square Foot) | ft² | 900 | ||
Operating Lease, Monthly Expense | $ 4,500 |
Note 5 - Leases - Summary of Ma
Note 5 - Leases - Summary of Maturities of Lessee Operating Lease Liabilities (Details) | Mar. 31, 2023 USD ($) |
2023 (excluding the three-months ended March 31, 2023) | $ 198,000 |
2024 | 59,000 |
Total lease payments | 257,000 |
Less imputed interest | (6,000) |
Total | $ 251,000 |
Note 5 - Leases - Lease Cost an
Note 5 - Leases - Lease Cost and Information (Details) - USD ($) | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Operating lease cost | $ 103,000 | $ 100,000 |
Sublease income | (50,000) | (43,000) |
Total lease cost | 53,000 | 57,000 |
Cash paid for amounts included in the measurement of lease liabilities - Operating leases | $ 103,000 | $ 100,000 |
Weighted-average remaining lease term - Operating leases in years (Year) | 11 months 12 days | 1 year 9 months |
Weighted-average discount rate - Operating leases | 5.54% | 5.78% |
Note 6 - Per Share Amounts (Det
Note 6 - Per Share Amounts (Details Textual) - shares | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Incremental Common Shares Attributable to Dilutive Effect of Share-Based Payment Arrangements (in shares) | 166,000 | 98,000 |
Share-Based Payment Arrangement, Option [Member] | ||
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares) | 6,000 | 50,000 |
Restricted Stock [Member] | ||
Incremental Common Shares Attributable to Dilutive Effect of Share-Based Payment Arrangements (in shares) | 123,000 | 123,000 |
Note 6 - Per Share Amounts - Co
Note 6 - Per Share Amounts - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($) | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Net income attributable to American Shared Hospital Services | $ 188,000 | $ 269,000 |
Weighted average common shares for basic earnings per share (in shares) | 6,306,000 | 6,201,000 |
Dilutive effect of stock options and restricted stock awards (in shares) | 166,000 | 98,000 |
Weighted average common shares for diluted earnings per share (in shares) | 6,472,000 | 6,299,000 |
Basic earnings per share (in dollars per share) | $ 0.03 | $ 0.04 |
Diluted earnings per share (in dollars per share) | $ 0.03 | $ 0.04 |
Note 7 - Stock-based Compensa_3
Note 7 - Stock-based Compensation (Details Textual) - Incentive Compensation Plan [Member] - USD ($) | 3 Months Ended | ||
Mar. 31, 2023 | Mar. 31, 2022 | Jun. 30, 2021 | |
Common Stock, Capital Shares Reserved for Future Issuance (in shares) | 2,580,000 | ||
Share-Based Payment Arrangement, Expense | $ 96,000 | $ 87,000 | |
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount | $ 129,000 | ||
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year) | 4 years | ||
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value (in dollars per share) | $ 1.63 |
Note 7 - Stock-based Compensa_4
Note 7 - Stock-based Compensation - Summary of Stock Option Activity (Details) - USD ($) | 3 Months Ended | 12 Months Ended | ||
Mar. 31, 2023 | Mar. 31, 2022 | Dec. 31, 2022 | Dec. 31, 2021 | |
Outstanding (in shares) | 95,000 | 67,000 | 67,000 | |
Outstanding, grant date weighted-average exercise price (in dollars per share) | $ 2.76 | $ 2.72 | $ 2.72 | |
Outstanding, weighted average remaining contractual life (Year) | 3 years 1 month 2 days | 4 years 9 months 29 days | 3 years 3 months 29 days | |
Granted (in shares) | 50,000 | |||
Granted (in dollars per share) | $ 2.93 | |||
Granted (Year) | 7 years | |||
Forfeited (in shares) | (2,000) | |||
Forfeited (in dollars per share) | $ 3.90 | |||
Outstanding, intrinsic value | $ 4,000 | $ 0 | ||
Exercisable (in shares) | 48,000 | 59,000 | ||
Exercisable, grant date weighted-average exercise price (in dollars per share) | $ 2.73 | $ 2.72 | ||
Exercisable, weighted average remaining contractual life (Year) | 2 years 9 months 7 days | |||
Outstanding (in shares) | 143,000 | 67,000 | 95,000 | 67,000 |
Outstanding, grant date weighted-average exercise price (in dollars per share) | $ 2.80 | $ 2.72 | $ 2.76 | $ 2.72 |
Minimum [Member] | ||||
Outstanding, weighted average remaining contractual life (Year) | 4 years 9 months 3 days | |||
Exercisable, weighted average remaining contractual life (Year) | 2 years 6 months 3 days | |||
Maximum [Member] | ||||
Outstanding, intrinsic value | $ 26,000 |
Note 9 - Commitments (Details T
Note 9 - Commitments (Details Textual) - USD ($) | 3 Months Ended | |
Sep. 04, 2022 | Mar. 31, 2023 | |
Leksell Gamma Knife Icon Systems and Linear Accelerator System [Member] | ||
Long-term Install Service and Purchase Commitment, Amount | $ 16,228,000 | |
Long-term Commitment, Cash on Hand to Fund | 13,201,000 | |
Long-term Commitment, Line of Credit to Fund | 7,000,000 | |
LINAC System [Member] | ||
Long-Term Service Commitment, Amount | $ 15,168,000 | |
LINAC System [Member] | Maximum [Member] | ||
Long-Term Service Commitment, Period (Year) | 9 years | |
LINAC System [Member] | Minimum [Member] | ||
Long-Term Service Commitment, Period (Year) | 5 years | |
Mevion PBRT Units [Member] | Upgrade and Purchase MEVION Systems [Member] | ||
Long-term Purchase Commitment, Amount | $ 34,000,000 | |
Mevion Medical Systems Inc [Member] | Maintenance And Support Agreement, Mevion Service Agreement [Member] | ||
Purchase Agreement Annual Prepayment | $ 1,800,000 | |
Long-term Purchase Commitment, Period (Year) | 1 year |
Note 10 - Related Party Trans_3
Note 10 - Related Party Transactions (Details Textual) | Mar. 31, 2023 USD ($) |
US Subsidiary Of Elekta Member | |
Purchase Obligation | $ 20,208,000 |
GKF Subsidiary [Member] | |
Noncontrolling Interest, Ownership Percentage by Parent | 81% |
US Subsidiary Of Elekta Member | |
Noncontrolling Interest, Ownership Percentage by Parent | 19% |
Note 10 - Related Party Trans_4
Note 10 - Related Party Transactions - Schedule of Related Party Transactions (Details) - US Subsidiary Of Elekta Member - USD ($) | 3 Months Ended | ||
Mar. 31, 2023 | Mar. 31, 2022 | Dec. 31, 2022 | |
Equipment purchases and de-install costs | $ 201,000 | $ 1,232,000 | |
Costs incurred to maintain equipment | 295,000 | 269,000 | |
Total related party transactions | 496,000 | $ 1,501,000 | |
Related Party [Member] | |||
Accounts payable, asset retirement obligation and other accrued liabilities | $ 791,000 | $ 857,000 |