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DATE

Thursday, Aug. 13, 2026 at 1 p.m. ET

CALL PARTICIPANTS

• Investor Relations - Kirin Smith
• Executive Chairman - Raymond C. Stachowiak
• Interim Chief Executive Officer - Craig K. Tagawa
• Interim Chief Financial Officer - Alexis N. Wallace

TAKEAWAYS

• Total Revenue -- $8.4 million in the second quarter, representing a 19.2% increase driven by growth in direct patient services and proton beam radiation therapy activity.
• Direct Patient Services Revenue -- $4.9 million, growing 40% year over year due to higher procedure volumes at centers in Rhode Island, Peru, and Mexico.
• Proton Beam Radiation Therapy Revenue -- $2.3 million, a 22% increase reflecting higher treatment volumes and improved average reimbursement.
• First Half Revenue -- $15.5 million, an 18% increase compared with the first six months of the prior year.
• Operating Cash Flow -- $4.4 million generated during the first half of 2026, reflecting improved operating performance and disciplined working capital management.
• Cash Balance -- $6.8 million at June 30, 2026, an 80% increase since the beginning of the year.
• Net Loss -- $514,000, or $0.07 per diluted share, compared with a net loss of $280,000 in the prior-year period.
• Allowance for Credit Losses -- $909,000 recorded against Rhode Island receivables from periods prior to May 31, 2025.
• Legal and Professional Costs -- $285,000 associated with negotiating the third amendment to the company's credit agreement.
• Adjusted EBITDA -- $1.3 million for the quarter, compared with $1.7 million in the second quarter of 2025.
• PBRT Treatment Fractions -- Increased approximately 10% year over year during the second quarter.
• International Gamma Knife Revenue -- $2.7 million for the first half of 2026, a 56% increase following technology upgrades at international centers.
• Medical Equipment Leasing Revenue -- $6.6 million for the first half of 2026, remaining stable as higher proton beam revenue offset the expiration of a domestic Gamma Knife contract.
• Interest Expense -- $301,000 for the quarter, a decrease from $428,000 in the prior-year period due to lower average debt balances.
• Current Portion of Long-Term Debt -- $16.2 million at June 30, 2026, down from $17.3 million at the end of 2025.
• Shareholders' Equity -- $23.1 million, or approximately $3.49 per share, as of the end of the second quarter.
• Subordinated Financing -- $2 million invested by an entity controlled by the Executive Chairman subsequent to quarter end to enhance liquidity.
• Gross Margin -- $1.4 million in the second quarter, representing a sequential improvement from $1.3 million in the first quarter of 2026.
• Total Debt Commitment -- $15.5 million owed to Fifth Third Bank as of the current period, with a projected reduction to $13.3 million by June 2027.

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RISKS

• Executive Chairman Stachowiak stated, "While we recognize there is still important work ahead of us, particularly regarding our balance sheet," when discussing the company's capital structure and debt obligations.
• Management acknowledged a $909,000 reduction in the viability of receivables from insurance carriers relating to services performed prior to June 2025.
• The company entered into a forbearance agreement with its primary lender, which includes a provision to pursue a sale of all or any portion of the assets of American Shared Hospital Services (AMS -3.92%).

SUMMARY

Management reported that the company has transformed from an equipment leasing firm into a diversified radiation oncology platform. Revenue growth was driven by increased utilization in the direct patient services segment, which now accounts for more than half of total quarterly revenue. The company is currently operating under a third amendment and forbearance agreement with its primary lender while exploring long-term capital solutions and refinancing options. Operational focus remains on increasing patient throughput across the installed base of Gamma Knife and proton beam radiation therapy systems while expanding the company's footprint in Rhode Island and Latin America.

• The company promoted Alexis N. Wallace to Interim Chief Financial Officer following the departure of the previous CFO.
• The installation of the ESPRIT system upgrade in Lima, Peru, has reduced treatment times and improved patient throughput.
• The company is partnering with Hospital San Javier in Guadalajara, Mexico, to upgrade its existing Gamma Knife center.
• Management is advancing development opportunities in Rhode Island for a new radiation therapy center in Bristol and a proton beam center in Johnston.
• Interim CEO Tagawa stated, "Increasing patient throughput remains the single greatest driver of long term value creation within our business."
• The credit agreement with Fifth Third Bank provides a maturity extension to June 30, 2027, to facilitate refinancing or strategic alternatives.

INDUSTRY GLOSSARY

• Gamma Knife: A non-invasive stereotactic radiosurgery system used primarily for treating brain tumors and other neurological conditions.
• Proton Beam Radiation Therapy (PBRT): An advanced form of precision radiation therapy that uses protons rather than x-rays to treat cancer.
• ESPRIT: The latest generation of Leksell Gamma Knife technology offering improved clinical efficiency.
• Certificate of Need (CON): A regulatory approval required in certain U.S. states before healthcare providers may expand or establish new facilities.
• Direct Patient Services (DPS): A business model where the company operates treatment centers and bills for clinical services rather than leasing equipment to hospitals.

Full Conference Call Transcript

Operator: Good day, and welcome to the American Shared Hospital Services Second Quarter 26 Earnings Conference Call. All participants will be in a listen only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by 0. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star, then 1 on a touch tone phone. To withdraw your question, please press star, then 2. Please note this event is being recorded. I would now like to turn the conference over to Kirin Smith, Investor Relations. Please go ahead.

Kirin Smith: Thank you, Nick, and thank you everyone for joining us today. AMS' second quarter 26 earnings press release was issued earlier today. If you need a copy, it can be accessed on the company's website at www.asashs.com under the Investors section. Before turning the call over to management, I would like to make the following remarks concerning forward looking statements. Please note that various remarks that may be made on conference call about future expectations, plans and prospects for the company constitute forward looking statements for the purposes of Safe Harbor provisions under the Private Securities Litigation Reform Act of 2 thousand.

Actual results may vary materially from those indicated by these forward looking statements as a result of various important factors, including those discussed in the company's filings with the SEC including the company's annual report on Form 10 ks for the year ended 12/31/2025, and Form 10 Q for the quarter ended 03/31/2026, Company assumes no obligation to update this information contained on this conference call. I turn the call over to management, I would like to remind everyone about our Q&A policy where we provide each participant the time to ask 1 question and 1 follow-up. As always, we will be happy to take additional questions offline.

With that, I would now like to turn the call over to Raymond C. Stachowiak, Executive Chairman. Raymond, please go ahead.

Raymond C. Stachowiak: Thank you, Kirin, and good afternoon, everyone. For joining us today and for your continued interest in American Shared Hospital Services. Before we begin, I would like to take a moment to point out that we recently promoted Alexis N. Wallace our longstanding Chief Accounting Officer to the role of Interim CFO. Our previous CFO, Scott Raymond Frech, has moved on to pursue other endeavors. We wish Scott all the best and appreciate his contributions while welcoming Alexis to this well deserved role. After her many years of excellent service on our accounting team. Now let's get into the quarter. The second quarter represented another period of meaningful operational progress for our company.

We delivered strong quarterly revenue of approximately 8.4 million representing year over year growth of 19% while first half revenue increased 18% to more than 15.5 million These results were driven by continued strength across our direct patient services business increasing proton beam radiation therapy activity and improving performance from our international operations. More importantly, we believe these results validate the strategic direction we have been executing over the past several years. We have intentionally transformed American Shared Hospital Services from a company primarily dependent on equipment leasing into a more diversified radiation oncology platform with multiple avenues for growth.

Today, we benefit from recurring revenues generated through our direct patient care operations longstanding hospital partnerships international treatment centers, Gamma Knife's leadership, and our participation in proton beam radiation therapy. Each of these businesses contribute to our overall growth strategy. But together they provide us with a broader, more resilient operating platform than at any point in our history. 1 of the most encouraging trends we continue to see is improving utilization across our network. Our Rhode Island centers continue to experience higher patient volumes and improved operating performance. Our proton beam radiation therapy partnership in Orlando, Florida delivered another strong quarter. Benefiting from increased treatment volumes and favorable reimbursement trends.

Internationally, our Gamma Knife center in Peru continues to demonstrate increased treatment volumes compared with the prior year following the ESPRIT upgrade that we completed in 2025. These operational achievements are especially encouraging because higher utilization remains 1 of the most important drivers of long term profitability our business model. I am also proud to report that our operating activities over the first 6 months generated $4.4 million of cash And our cash balance at the end of the second quarter increased over 80% since the beginning of this year to $6.8 million It is validating to see the improving cash generating capability of our business as our operating performance continues to strengthen.

We also made important progress subsequent to quarter end. With respect to our capital structure. As many of you know, we entered into a third amendment and forbearance agreement with Fifth Third Bank Although our financing discussions have required considerable management attention, over the past several months we believe the agreement provides a defined framework that allows us to remain focused on executing our operating strategy while we continue pursuing longer term capital solutions. A few months ago, I formed a new company that recently purchased additional shares of our company from a private investor.

In addition, this new company has invested $2 million of subordinated financing after quarter end which reflects our continued confidence in the long term prospects of the company and provides additional financial flexibility as we move forward. Importantly, none of these financing activities have changed our long term strategic priorities. In Rhode Island, we continue advancing opportunities created through our Certificate of Need approval. Including plans for our new radiation therapy center in Bristol, and a proton beam radiation therapy center in Johnston. Internationally, we remain excited about the continued development of our operations in Latin America and the opportunities we see to further expand our presence in attractive markets.

An important component of our international growth strategy is in Guadalajara, Mexico. Where we are partnering with Hospital San Javier to upgrade their Gamma Knife center Importantly, this is an established Gamma Knife market and a well established clinical partner. Hospital San Javier has been providing Gamma Knife treatments since 1.99 thousand. Giving us an experienced physician and institutional platform from which to build. While we recognize there is still important work ahead of us, particularly regarding our balance sheet, I remain extremely confident in the underlying strength of our business.

Our focus remains squarely on growing patient volume, expanding and diversifying our installed base of advanced radiation therapy technologies strengthening our partnerships with leading healthcare systems and allocating capital where we believe it can generate attractive long term returns. With that, I will turn the call over to our Interim CEO, Craig K. Tagawa, who will provide more detail on our operational performance. Craig?

Craig K. Tagawa: Thank you, Raymond, and good afternoon, everyone. I would also like to thank all of you for joining us today and for your continued interest in American Shared Hospital Services. The second quarter was another quarter of solid operational execution and meaningful progress across our businesses. While our reported financial results include several substantial items, that Alexis will discuss in greater detail. I believe the most important takeaway from the quarter is that the underlying business continues to move in the right direction. We generated strong quarterly revenues of approximately 8.4 million representing 19% year over year growth.

While first half revenues increased to more than 15.5 million Those results were driven by continued growth in our direct patient services segment. Improving proton beam radiation therapy performance and higher procedure volumes across our international Gamma Knife operations. More importantly, we continue to see encouraging trends in the metrics that matter most to the long term success of our business. Patient volumes, utilization, physician engagement, and central level operating performance. Beginning with Rhode Island, our 3 radiation oncology centers continued to improve during the quarter. These facilities once again generated strong revenue growth, supported by increased patient procedures continued operational improvements.

Since acquiring these centers, our primary objective has been to strengthen physician relationships, improve operational execution, and expand patient access to high quality radiation therapy services. We believe we are making meaningful progress against each of those objectives. While there is still additional opportunities ahead, we are encouraged by the trajectory of these operations and believe they represent an important long term growth platform for the company. Our Pueblo Mexico radiation therapy center also delivered another strong quarter Patient activity remained healthy, reimbursement trends continue to be favorable. And the operational improvements we have implemented over the past year are translating into better financial performance.

Pueblo continues to demonstrate the value of our international operating strategy we believe it provides a strong foundation for operational opportunities throughout Latin America. Turning to proton beam radiation therapy. Our leasing arrangement in Orlando delivered another excellent quarters. Revenues increased over 22% year over year as both treatment volumes and reimbursement improved Photon beam radiation therapy remains an important component of our diversified treatment portfolio, and we are pleased with the continued performance of this asset. Our Gamma Knife business also continued to make encouraging progress. While domestic leasing volumes continue to reflect the expiration of 1 customer agreement last year, we experienced strong growth across our international Gamma Knife centers.

The ESPRIT upgrade completed in Peru last year continues to produce operational benefits through shorter treatment times, improved patient throughput and higher utilization. We believe these improvements demonstrate the value of continuing to invest in next generation technology across our installed base. As we look across the entire organization, 1 theme continues to stand out. Utilization, Increasing patient throughput remains the single greatest driver of long term value creation within our business. Many of our facilities have significant operating leverage. As procedure volumes continue to increase, we expect that incremental revenue will increasingly translate into improved profitability and stronger cash generation. That remains central focus for our management team.

Beyond our current operations, we are also excited about the opportunities ahead. In Rhode Island, we continue to work toward development opportunities associated with our previously approved certificates of need. These projects have the potential to significantly expand our presence in 1 of our strongest operating markets and represents an important component of our long term growth strategy. As Ray mentioned earlier, we also made important progress regarding our financing capabilities after quarter end. While much of the public attention has understandably focused on the balance sheet, I believe it is equally important to recognize the progress occurring throughout our operating business.

Revenue continues to grow patient volumes continue to improve, clinical partners remain strong and our operating teams continue to exercise execute at a very high level. Taken together, these trends reinforce our confidence that the business is becoming stronger and better positioned for sustainable long term growth. While there is still work ahead, I believe the progress we are making today lays the foundation for meaningful long term value for our shareholders. With that, I will turn the call over to our Interim Chief Financial Officer, Alexis N. Wallace, who will review our financial results in greater detail. Alexis?

Alexis N. Wallace: Thank you, Craig, and good afternoon, everyone. As Craig highlighted, the second quarter reflected continued operating across our business. We delivered strong growth in our direct patient services platform solid improvement in operating cash flow, and continued progress strengthening our liquidity. While reporting earnings reported earnings were by several significant items during the quarter. We believe our underlying operating performance continued to improve and provides a solid foundation for future growth. Beginning with revenue, total revenue for the second quarter increased 19.2% to approximately 8.4 million compared with $7.1 million in the prior year period. For the first 6 months of 2026, revenue increased 17.7% to approximately 15.5 million from $13.2 million in the first half of 25.

The primary driver of this performance continued to be our direct patient services segment. Second quarter Direct Patient Services segment revenue increased approximately 40% to 4.9 million while first half revenue increased 35% to approximately 8.9 million This growth was driven by primarily higher patient procedure volumes at our Rhode Island radiation oncology centers together with another strong quarter from our Peru and Pueblo, Mexico facilities. Importantly, these centers continue to demonstrate the operating leverage we anticipated when we made these investments. As patient volumes continue to grow, we believe this business will become an increasingly meaningful contributor to both revenue growth and long term profitability.

Within our Medical Equipment Leasing segment, overall revenue remained relatively stable compared with the prior year. While domestic Gamma Knife leasing activity reflected the expiration of 1 customer agreement during 2025, This was substantially offset by continued strength in our proton beam radiation therapy business. Proton beam radiation therapy revenue increased 22% to approximately 2.3 million during the quarter and approximately $4.3 million for the first 6 months of the year. Benefiting from both higher treatment volumes and improved reimbursement levels. Gamma Knife revenue also increased modestly during the quarter as procedure volumes continued recovering at our international treatment centers, following completion of the Esprit upgrade in Lima.

Improved efficiency of the upgraded platform has enhanced patient throughput and contributed to stronger operating performance across our international operations. Turning to profitability, gross margin for the quarter was approximately 1.4 million while modestly below last year's level and improved sequentially from the first quarter of 26 despite the continued expansion of our direct patient services business which carries a different cost structure than our traditional equipment leasing operation. We believe this reflects continued operational execution as we scale that business. Adjusted EBITDA for the second quarter was approximately $1.3 million compared with 1.7 million in the prior year quarter.

On a year to date basis, adjusted EBITDA totaled approximately 2.5 million reflecting the continued cash generating strength of our operating platform. Moving further down the income statement, selling and administrative expenses increased year over year primarily reflecting legal and professional costs of $285 thousand associated with negotiating the third amendment to our credit agreement. In addition, we recorded a higher allowance for credit losses of 909 thousand against Rhode Island receivables prior to 05/31/2025. As we mentioned in prior calls, we have been focused on improving our accounts receivable and billing systems and have made good progress in that area. So we are well positioned going forward.

These 2 items represented the primary drivers of the increase in our reported net loss during the quarter. We view both as largely independent of the operating trends within the business. Excluding these items, our core operations continue to perform well. Supported by higher patient volumes, improving reimbursement trends and disciplined operating execution. Another encouraging development was the continued decline in interest expense as our average debt balances decreased. Reflecting and our ongoing efforts to strengthen our balance sheet. Turning to liquidity, we ended the quarter with approximately $6.8 million in cash. Cash equivalents and restricted cash. Compared with $3.7 million at year end of 2025.

Perhaps most encouraging, operating activities $4.4 million of cash during the first 6 months of the year. The strong cash generation enabled us to fund scheduled debt repayments and distributions to our minority partners while simultaneously increasing our cash position. We believe this demonstrates the improving cash generating capability of our business as operating performance continues to strengthen. Subsequent to quarter end, we completed the previously announced third amendment and forbearance agreement with Fifth Third Bank. This agreement provides additional flexibility as we continue evaluating longer term financing alternatives and executing our strategic priorities. Additionally, we completed the $2 million subordinated from a newly created company formed by our Executive Chairman.

Together, these actions enhance our liquidity provide additional financial flexibility, and allow management to remain focused on executing our operating strategy on pursuing opportunities to further strengthen our capital structure. Looking ahead, our financial priorities remain clear. First, continuing driving sustainable revenue growth by increasing utilization across our existing treatment network while expanding our installed base of advanced radiation therapy technologies. Second, translate that revenue growth into improved profitability and operating cash flow through disciplined execution and continued operating And third, continue strengthening our balance sheet and capital structure while maintaining the flexibility necessary to support future growth opportunities and create long term shareholder value. Overall, we are encouraged by the progress achieved during the first half of 26.

The underlying fundamentals of our business continue to improve Our operating cash flow remains strong. Demand across our treatment platform is healthy, and we believe the company is well positioned to build on this momentum during the remainder of the year. With that, Nick, you may open up the call for any questions.

Operator: Thank you. We will now begin the question and answer session. To ask a question, you may press star then 1 on your touch tone phone. If you are using a speakerphone, please pick up your handset before the keys. Then 2. At this time, we will pause momentarily to assemble the roster. The first question will come from Marla Marin with Zacks. Please go ahead.

Marla Marin: So on the back of the strength of this quarter, I think when you originally went down the path of growing the direct patient operations 1 thing you talked about was having much greater control over procedure volumes and control over the ability to drive volume increases. And it seems based on what you have discussed on prior conference calls or this call, that there are a lot of opportunities for that particularly in Rhode Island. We have 3 centers. You have the relationship with the Brown healthcare system and you will be opening over time 2 new centers.

Do you think that you will have the same ability to control and drive procedure volume increases in some of the international facilities.

Operator: Thanks for your question, Kirin.

Raymond C. Stachowiak: This is Raymond C. Stachowiak, Executive Chairman. Yes. We will be growing have been growing our volumes at our international sites. Peru has seen substantial volume increases, especially since we upgraded their technology to the latest and greatest ESPRIT model, Gamma Knife. And our linear accelerator in Pueblo, has also experienced increases in volumes. We are also excited about the opportunity to proceed forward with the Gamma Knife upgrade in Guadalajara, Mexico in our relationship with San Javier Hospital there. We are anxious to get that project going and moving forward as well. And, yes, by having greater control and negotiating expanding our relationships with our hospital partners, that is been a key consideration in our business model. Thank you.

Operator: The next question will come from Tony Kamin with Eastwood Partners. Please go ahead.

Tony Kamin: Yes. Hi. First, you know, it is I think it is really notable that with all the sort of investment in kind of collecting of different opportunities The company really at this point seems like it is starting to get the benefits of that and starting to fire on all cylinders, which is really encouraging.

I also noted that Raymond, you Craig, and Alexis all mentioned the word, you know, long term in the in the sense that you know, growing the value of the company for shareholders long term and as a long term shareholder, and I am sure all long term shareholders really be excited to get the full value of all these all these investments starting to fire in the right direction.

However, I am trying to reconcile that with when I look at the third amendment, on page 31 of it, it says the, the loan parties shall cause their respective subsidiaries to pursue a sale of all or any portion of all of the assets of ASHS So mean, that seems pretty clear too that in your agreement, it mentions Lake Street, it mentions bid books that you have to start to try to sell the company I guess I would have preferred that maybe you were able to replace this loan agreement with 1 from another institution see it enough to do that. But again, it is seems it is written very clearly.

So again, in the interest of wanting to capture the long term opportunity here, how do you do that with, at the same time, being entering into agreement where you have to sell? All or part of the company.

Raymond C. Stachowiak: Well, think it is fair to say we are any and all options it is very clear that we have been given a 12-month extension of maturity plus over 12 month extension of the maturity of our loans, to 06/30/2027. So our credit agreement with Fifth Third buys us some time so that we can pursue these different options. We owe Fifth Third about 15.5 million by the end of June of next year. It will be down to about 13.3 million. If you look at our business, we generated 4.4 million of cash in the first 6 months of this year. That number is going to be right off our statement of changes.

In financial position, $4.4 million of cash generation. We ended the quarter with $6.8 million of cash plus the $2 million deposit we have as well. So I think we are gonna be able to find a solution over this period of time to refinance our indebtedness with Fifth Third Bank. That will not necessarily require us sale of the company? We are looking at any and all options. As I would expect our shareholders to expect us to do. So we are pursuing any and all options. And we are confident reach a solution. Greg. Thank you very much. Mhmm.

Operator: Next question will come from Anthony Marchese Private Investor. Please go ahead.

Anthony Marchese: Yes. Hi, Raymond. I am trying to figure out how a almost a million-dollar charge for accounts receivable occurs over a year later. I just do not I mean, is it 1 account, multiple I am just trying to figure out what happened. And it just seems like every quarter, there is something. If it is not a center that was closed, it was maintenance, if not maintenance now, it is, you know, accounts receivable. It just seems like every quarter, the company has some hiccup.

So I am just trying to figure out what was the nature, if you could, in more detail, of the $900 thousand accounts receivable charge and why it took this long to figure it out.

Raymond C. Stachowiak: Tony, your comments are very much appreciated. It kinda stands on its own. We had receivables through 05/31/2025, that related to several payers and our relationship with those payers And they reached a point where we expect to have a $909 thousand reduction. And viability of those receivables. I am not trying to be difficult. I am not sure what that means. Are the payers bankrupt? Do they not wanna pay you? Was there an issue with the sir I am just trying to figure out it is some it is fairly large. So I am just trying to figure out all these payers When you call them payers, are these insurance companies? Are these clients?

Or are these are these people who you know, got treatment and then could not afford it or just trying to figure out the nature of that charge. Mhmm. Yeah. For the most part, it comes from the insurance carriers. That we have relationships with. And was there an overriding theme as to why they would not pay you? I mean, these are insurance companies. These are fairly sophisticated, I would think. Sophisticated institutions are not just going to say, I do not wanna pay you. You know, for no reason.

So I am just wondering, was it because the service was not performed properly or there was some issue with the service And I am not trying to be difficult, Raymond. I am just trying to know, can this happen again? And if it does, how does it happen? We are not proud of it, Tony. We are not proud of it. But it is well, of course not. Okay. Thank you.

Operator: This will conclude our question and answer session. I would like to turn the conference back over to Craig Tagawa for any closing remarks.

Craig K. Tagawa: Thank you, Nick, and thank you to everyone who joined us today. Before we conclude, I would like to leave you with 3 key takeaways from today's discussion. First, our operating business continues to perform well. We delivered strong quarterly revenue continued to increase patient volumes across multiple treatment platforms and generated strong operating cash flow during the first half of the year. Second, the strategic investments we have made over the past several years are producing meaningful results. Our direct patient services business continues to grow. Our international operations are gaining momentum. And we have an exciting pipeline of future expansion opportunities that we believe will support long term value creation.

Finally, while we remain focused on strengthening our balance sheet, we have taken important steps to enhance our financial flexibility and remain committed to executing our long term strategy with discipline and transparency. I would like to thank our physicians, clinical teams, employees, hospital partners, and shareholders for their continued confidence and support. We appreciate your interest in the American Shared Hospital Services and look forward to updating you on our continued progress next quarter. Thank you everyone and have a great evening.

Operator: The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.