Q1 2025 American Shared Hospital Services Earnings Call

Operator: Good day, and welcome to the American Shared Hospital Service's first quarter 2025 earnings conference call. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key, followed by zero.

Good day and welcome to the American shared hospital services first quarter 2025 earnings Conference call.

All participants will be in listen only mode.

You need assistance. Please signal a conference specialist by pressing the star key followed by zero.

Operator: 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.

After today's presentation there'll be an opportunity to ask questions to ask a question you May Press Star then one on a touchtone phone to withdraw your question. Please press Star then two.

Speaker Change: Note. This event is being recorded I would now like to turn the conference over to Karen Smith with P. C. G Advisory. Please go ahead.

Kirin Smith: I would now like to turn the conference over to Kirin Smith with PCG Advisory. Please go ahead. Thank you, Wyatt, and thank you, everyone, for joining us today.

Thank you Mike and thank you everyone for joining us today any messages first quarter of 2025 earnings press release was issued before the market opens if you need a copy can be accessed on the company's website at www Dot a S. H S dot com at press releases under the Investor.

Kirin Smith: AMS's first quarter 2025 earnings press release was issued today before the March. If you need a copy, it can be accessed on the company's website at www.ashs.com at press releases under the investors tab.

Speaker Change: Your staff.

Kirin Smith: 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 this 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 1995. Actual results may differ varied 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 FBI.

Speaker Change: Before turning the call over to management I would like to make a problem in the remarks concerning forward looking statements. Please note that various remarks that maybe made on this 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 99.

Speaker Change: 85.

Speaker Change: Actual results may differ materially.

Speaker Change: 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-K for the year ended December 31 2024.

Kirin Smith: This concludes the company's annual report on Form 10-K for the year ended December 31, 2024. The company assumes no obligation to update the information contained in this report.

Speaker Change: <unk> assumes no obligation to update information contained in this conference call before I turn the call over to Ray I'd like to remind everyone about our Q&A policy.

Kirin Smith: Before I turn the call over to Ray, I'd like to remind everyone about our Q&A policy, where we provide each participant the time to ask one question and one follow-up. As always, we'll be happy to take additional questions offline.

Speaker Change: We provide each participant the time to ask one question and one follow up as always we'll be happy to take additional questions offline.

Raymond Stachowiak: With that, I'd now like to turn the call over to Ray Stachowiak, Executive Chairman. Ray, please go ahead. Thank you, Kirin, and good afternoon, everyone. Thanks for joining us today for our first quarter 2025 earnings conference. I'll begin with some opening remarks, then turn the call over to Gary, our CEO, for additional detail, followed by Scott Frech, our CFO, for a financial review of our first quarter results.

Speaker Change: With that I'd now like to turn the call over to race to Kodiak Executive Chairman Ray. Please go ahead.

Ray: Thank you Karen and good afternoon, everyone.

Ray: Thanks for joining us today for our first quarter 2025 earnings call.

Ray: I'll begin with some opening remarks, then turn the call over to Gary our CEO for additional detail.

Ray: Followed by Scott Fracs, our CFO for a financial review of our first quarter results.

Raymond Stachowiak: Following our prepared remarks, we'll open the call for questions. We are pleased with our first quarter 2025 revenue growth, which was driven by the expansion of our direct patient services segment and additional international business development initiatives. While we did see treatment volumes decline this past quarter, we are clearly beginning to see the benefits from our transition from a cancer treatment equipment leasing focus to a more patient-centric service model. And I'm pleased to report that we are seeing treatment volumes pick back up and look forward to a stronger back half of 2025. For the past quarter, we saw double-digit revenue growth, which increased 17 percent year-over-year.

Speaker Change: Following our prepared remarks, we'll open the call for questions.

Speaker Change: We are pleased with our first quarter 2025 revenue growth, which was driven by the expansion of our direct patient services segment.

Speaker Change: And additional international business development initiative.

Speaker Change: While we did see treatment volumes declined this past quarter, we are clearly beginning to see the benefits from our transition from a cancer treatment equipment lease rent fault guests to more patient centric service model now.

Speaker Change: I'm pleased to report that we are seeing treatment volumes pick back up and look forward to a stronger back half of 2025.

Speaker Change: For the past quarter, we saw double digit revenue growth, which increased 17% year over year.

Raymond Stachowiak: This growth was driven by the continued benefit from the Rhode Island acquisition that we closed last year, as well as from the opening of our new radiation therapy treatment facility in Puebla, Mexico. As we focus on revenue growth, we also remain focused on profitability. Our first quarter 2025 adjusted EBITDA came in at $949,000. compared to 1.75 million in first quarter 2024 due to lower procedure by. We continue to have strong cost controls in place with very fixed costs, and we are relying on the treatment volumes and the number of patients served to drive our top-line growth.

Speaker Change: This growth was driven by the continued benefit from the Rhode Island acquisition that we closed last year.

Speaker Change: As well as from the opening of our new radiation therapy treatment facility and played one Mexico.

Speaker Change: As we focus on revenue growth, we also remain focused on profitability.

Our first quarter 2025, adjusted EBITDA came in at 949000.

Speaker Change: Compared to 1.75 million in first quarter 2020 for.

Speaker Change: Due to lower procedure.

Speaker Change: We continue to have strong cost controls in place with very fixed cost.

Speaker Change: And we are relying.

Speaker Change: Anthony.

Speaker Change: Number of patients served to drive our topline growth.

Raymond Stachowiak: It's very important for investors to recognize. that on a short-term and quarter-to-quarter basis, there will be fluctuation. due to the specific nature of our growing business. But over the long term, we are primed for strong, profitable growth. I urge investors to focus on the long-term overall growth opportunity. as we execute on our strategic initiatives and our upcoming milestones. We believe this is an opportune time for investors to follow our company closely. We do believe we are primed for long-term outperformance as we execute on both strategy and work towards building significant shareholder value.

Speaker Change: It's very important for investors to recognize that on a short term and quarter to quarter basis, there will be fluctuations due to the specific nature of our growing business, but over the long term, we are primed for strong profitable growth.

Speaker Change: I urge investors to focus on the long term overall growth opportunity as we execute on our strategic initiatives and our upcoming milestones.

Speaker Change: We believe this is an opportunity time opportune time for investors to follow our company closely.

Speaker Change: We do believe we are primed for long term outperformance as we execute on both strategy.

Speaker Change: And work towards building significant shareholder value.

Raymond Stachowiak: Before I hand the call over to Gary, I would also like to highlight our strong balance sheet, robust business development pipeline, and exciting strategic growth opportunities that drive our enthusiasm and confidence in the long-term trajectory of our company.

Speaker Change: Before I hand, the call over to Gary I would also like to highlight our strong balance sheet.

Gary: Robust business development pipeline and exciting strategic growth opportunities that drive orange, yeah, some and confidence in our long term trajectory of our company.

Gary Delanois: With that, I'll hand the call over to Gary Delanois, our CEO, for additional details. Thank you, Ray, and good afternoon, everyone. My confidence and enthusiasm for our business continues to grow, and I'm excited to lead the company into our next phase of growth with our strong management. We continue to reap the benefits from our acquisition of the three Rhode Island Cancer Treatment Centers and our newer one in Pueblo, Mexico. While it will not be straight up, we do expect the quarterly fluctuations in treatment volumes on the I am enthused by the growth we have seen in the overall business and even more so with our business development initiatives we have in motion.

Gary: With that I'll hand, the call over to Gary <unk>, our CEO for additional details Gary.

Gary: Thank you Ray and good afternoon, everyone.

Gary: My confidence and enthusiasm for our business continues to grow and I'm excited to lead the company into our next phase of growth with our strong management team.

Gary: We continue to reap the benefits from our acquisition of the three Rhode Island cancer treatment centers, and our new one newer one in <unk> Mexico.

Gary: While it will not be straight up we do expect the quarterly fluctuations in treatment volumes Aman.

Gary: I'm enthused by the growth we are seeing in the overall business and even more so with our business development initiatives, we have in motion.

Gary Delanois: At the Rhode Island Centers, our upgraded CT simulators used in the patient treatment planning and software enhancements for improved efficiency and patient care are in place and we are well positioned to show positive results for the long-term. Additionally, I'm pleased with staffing strategies that we put in place, and although we are not fully optimized yet, we have set the stage for increasing volumes and utilization to fuel future top and bottom line growth. I am confident that once we are fully staffed at each of our Rhode Island centers, we will see steady growth in treatment volumes and increased physician engagement with the health care community.

Gary: At the Rhode Island centers, our upgraded <unk> simulators used in the patient treatment planning and software enhancements for improved efficiency and patient care are in place and we are well positioned to show positive results for the long term.

Additionally, I am pleased with staffing strategies that we put in place and although we are not fully optimized yet we have set the stage for increasing volumes and utilization to fuel future top and bottom line growth.

Gary: I am confident that once we are fully staffed at each of our Rhode Island centers, we will see steady growth in treatment volumes and increased physician engagement with the health care community.

Gary Delanois: Furthermore, with our linear accelerators on service and maintenance agreements, this adds to their dependability and higher uptime for better patient service. The team continues to focus on strengthening our radiation therapy equipment leasing segment by working with our health system customers to create greater community awareness among referring physicians to drive increased utilization of their Gamma Knife systems, the gold standard for stereotactic radiosurgery. Our international business segment continues to represent a large growth opportunity where we are expecting continued momentum. As a reminder, we have the only Gamma Knife Centers in the countries of Peru and Ecuador. And with our third international center in Pueblo, Mexico, we are treating cancer patients for a full range of cancer diagnoses with the most advanced radiation therapy treatment capabilities available in our catchment area.

Gary: Furthermore, with our linear accelerators on service and maintenance agreements this adds to their dependability and higher uptime for better patient service.

Gary: The team continues to focus on strengthening our radiation therapy equipment leasing segment by working with our health system customers to create greater community awareness, among referring physicians to drive increased utilization of the gamma knife systems, the gold standard for stereotactic Radiosurgery.

Gary: Our international business segment continues to represent a large growth opportunity, where we are expecting continued momentum.

Gary: As a reminder, we have the only gamma knife centers in the countries of Peru and Ecuador.

Gary: And with our third International Centre in Puebla, Mexico, we are treating cancer patients for a full range of cancer diagnosis with the most advanced radiation therapy treatment capabilities available in our catchment area.

Gary Delanois: As you recall, last year we established our fourth international center with the signing of a joint venture agreement for a Gamma Knife Center in Guadalajara, Mexico. and we expect it to start treating patients and generating revenue towards the end of this year. This will be the only Esprit Gamma Knife in a country of 130 million people, which clearly represents an enormous benefit to the patients in Mexico and an untapped growth engine for us. As we look forward into the coming months and years ahead, we expect stronger international growth from additional treatment growth in Ecuador, strong volume from our newly upgraded center in Peru, and our two new centers in Guadalajara and Puebla.

Gary: As you recall last year, we established our first international center with the signing of a joint venture agreement for our Gamma knife Center in Guadalajara, Mexico, and we expect it to start treating patients and generating revenue towards the end of this year.

Gary: This will be the only esprit gamma knife in a country of 130 million people, which clearly represents an enormous benefit to the patients in Mexico, and an untapped growth engine for us.

As we look forward into the coming months and years ahead, we expect stronger international growth from additional treatment growth in Ecuador strong volume from our newly upgraded center in Peru, and our two new centers in Guadalajara <unk> outlook.

Gary Delanois: As Ray mentioned earlier, we continue to expand our business footprint in Rhode Island. The acquisition of a 60% majority interest in the three radiation therapy treatment centers in Rhode Island were our first direct patient services cancer treatment centers in the U.S. This new business segment clearly reflects the power of our growth strategy and further demonstrates our ability to partner with health systems, Care New England, and Prospect Charter Care, the second and third largest health systems in Rhode Island.

Gary: As Ray mentioned earlier, we continued to expand our business footprint in Rhode Island.

Gary: The acquisition of a 60% majority interest in the three radiation therapy treatment centers in Rhode Island, where our first direct patient services cancer treatment centers in the U S.

Gary: This new business segment, clearly reflects the power of our growth strategy and further demonstrates our ability to partner with health systems care, New England and prospect charter care, the second and third largest health systems in Rhode Island.

Gary Delanois: The second is the Certificate of Need, or CON, that we have been granted to build and operate a fourth radiation therapy center in Bristol, Rhode Island. And the third is a CON that we officially obtained this past December to build and operate the first proton beam radiation therapy center in the state of Rhode Island, which represents another major growth opportunity. We also have tuck-in acquisitions that we're working on and anticipate closing one by the end of this year. We look forward to announcing additional progress on these opportunities as they progress. Treatment volumes in cancer care can tend to ebb and flow from time to time due to changes in diagnosis mix, patient staging, and referring physician consults, and can result in lower treatment volumes that we experienced in the first quarter.

Gary: The second is the certificate of need or C. O N that we have been granted to build and operate a fourth radiation therapy center in Bristol, Rhode Island.

Gary: And the third is the C. O N that we officially obtained this past December to build and operate the first proton beam radiation therapy center in the state of Rhode Island, which represents another major growth opportunity.

Gary: We also have tuck in acquisitions that we're working on and anticipate closing one by the end of this year.

Gary: We look forward to announcing additional progress on these opportunities as they progress.

Gary: Treatment volumes in cancer care can tend to ebb and flow from time to time due to changes in diagnosis mix.

Gary: <unk> staging and referring physician comp salts and can result in lower treatment volumes that we experienced in the first quarter.

Gary Delanois: For the month of April, we have seen significant increases in treatment volumes for Gamma Knife, Proton Beam Radiation Therapy, and at the three Rhode Island Radiation Therapy Centers. Before I hand the call over to Scott, I'd like to reiterate our strong confidence. and our overall business. keep in mind that there will be quarterly fluctuations from time to time, as with most growth stage companies. But I feel very positive about the strategies we put in place for our long-term process. And I'm very excited and honored to work collaboratively with our strong management team to lead the company forward for continued revenue and profitability growth.

Gary: For the month of April we have seen significant increases in treatment volumes for gamma knife proton beam radiation therapy and at the three Rhode Island radiation therapy centers.

Gary: Before I hand, the call over to Scott I'd like to reiterate our strong confidence.

Scott Fracs: And our overall business keep in mind that there will be quarterly fluctuations from time to time as with most most growth stage companies, but I feel very positive about the strategies, we put in place for our long term prospects and I am very excited and honored to work collaboratively with our strong management team to lead the company forward.

Scott Fracs: For continued revenue and profitability growth.

Frech Scott: And with that, I'll turn the call over to Scott Frech, our CFO for a financial review. Thank you, Gary, and good afternoon. For the first quarter ended March 31st, 2025, total revenue increased 17% to $6.1 million, compared to $5.2 million in Q1 of 2024. Revenue from our direct patient services segment was $3.1 million per Q1 2025, compared to $963,000 in Q1 2024, marking an increase of 224%. This significant growth was primarily driven by the acquisition of the Rhode Island Radiation Therapy Operations and launch of operations in Pueblo, Mexico in the second half of 2024.

Scott <unk>: And with that I'll turn the call over to Scott <unk>, our CFO for a financial review.

Scott Fracs: Thank you Gary and good afternoon.

Scott Fracs: For the first quarter ended March 31, 2025, total revenue increased 17% to $6 1 million compared to $5 2 million in Q1 of 2024.

Revenues from our direct patient services segment was $3 1 million for Q1 2025 to 963000 in Q1 2024, marking an increase of 224%.

Scott Fracs: <unk> growth was primarily driven by the acquisition of the Orion in radiation therapy operation and launch of operations in Puebla, Mexico in the second half of 2024.

Frech Scott: Revenue from the equipment leasing segment decreased to $3 million from $4.3 million Q1 2024. Gamma Knife revenue declined 18% to $2.1 million for Q1 2025 compared to $2.6 million in Q1 2024. The number of Gamma Knight procedures in Q1 2025 was 208, a 24 percent decrease from the 273 procedures in 2024. The decline was primarily due to the expiration of two contracts in December 2024 and February 2025 and downtime to upgrade a third customer to a new elective spring. Revenue from proton beam radiation therapy decreased 38% to $1.6 million in Q1 2025 compared to $2.7 million in Q1 2024.

Scott Fracs: Revenue from the equipment leasing segment decreased to $3 million from $4 3 million in Q1 2020 for.

Scott Fracs: Gamma knife revenue.

Scott Fracs: Climbed 18% to $2 1 million for Q1, 2025 compared to $2 6 million in Q1 2024.

Scott Fracs: The number of gamma knife procedures in Q1, 2025 was 200, 824% decrease from the 220 273 procedures in 2024.

Scott Fracs: The decline was primarily due to the expiration of two contracts in December 2024, and February 2025, and downtime to upgrade a third customer to name a black screen.

Scott Fracs: Revenue from protein being proton beam radiation therapy decreased 38% to $1 6 million in Q1, 2025 compared to $2 7 million in Q1 2024.

Frech Scott: Total proton therapy fractions for Q1 2025 were 831, a 35% decrease from the 1,276 fractions in Q1 2024. This decline was primarily due to lower volume. Revenue from Linear Accelerator or the LINAC systems was $2.4 million for Q1 2025 compared to $0 in Q1 of 2024 due to the acquisition of the Rhode Island Radiation Therapy Operations and the launch of operations in Pueblo, Our gross margin for Q1 2025 was $942,000 compared to $2.1 million in Q1 2025. The decline in gross margin and percentage reflects increased operational expenses, higher staffing costs, and investment in technology infrastructure to support growth initiatives, as well as lower gamma nitrate in volumes and strong growth in our retail patient services segment, which has a lower gross margin percent.

Scott Fracs: Total proton therapy fractions for Q1, 2025 or 831 or.

Scott Fracs: 35% decrease from the 1276 fractions in Q1 2024.

Scott Fracs: This decline was primarily due to lower volumes.

Scott Fracs: Revenue from linear accelerator or linac systems was $2 4 million for Q1 2025 compared to zero in 2000 in Q1 of 2024 due to the acquisition of the Rhode Island radiation therapy operation and our launch of operations in Puebla Mexico.

Scott Fracs: Our gross margin for Q1, 2025 was $942000 compared to $2 1 million in Q1 2020 for the.

Scott Fracs: The decline in gross margin percentage reflects increased operational expenses higher staffing cost and investment in technology infrastructure to support growth initiatives as well as lower gamma knife treatment volumes and strong growth in our retail patient services segment, which has a lower gross margin percentage.

Frech Scott: Q1 2025 operating income was a loss of $1.3 million compared to a loss of $85,000 in Q1 2025. Net loss attributed to American Shared Hospital Services for Q1 2025 was $625,000 or $0.10 per diluted share, compared to net income of $119,000 or $0.02 per diluted share for Q1 2024. Adjusted EBITDA, our non-GAAP financial measure, was $949,000 for Q1 2025 compared to $1.75 million in Q1 2024.

Scott Fracs: Q1, 2025 operating income was a loss of $1 3 million compared to a loss of 85000 in Q1 2024.

Scott Fracs: Net loss attributable to American shared hospital services for Q1, 2025 was 625000 or 10 cents per diluted share compared to net income of 119000 or <unk> <unk> per diluted share for Q1 2024.

Scott Fracs: Adjusted EBITDA are non-GAAP financial measure was 949000 for Q1 2025 compared to $1 $75 million in Q1 2024.

Frech Scott: We ended Q1 2025 with strong financial position supported by our solid balance sheet. As of March 31st, 2025, cash and cash equivalents, including restricted cash, sit at $11.5 million compared to $11.3 million at December 31st, 2024. Shareholders' equity excluding non-controlling interests was $24.7 million, or $3.82 per outstanding share, compared to $25.2 million, or $3.92 per outstanding share at December 31, 2024. Fully Diluted Weighted Average Common Shares Outstanding for $6,572,000 for Q1 2025 and $6,576,000 for Q1 2024.

Scott Fracs: We ended Q1 2025 with strong financial position supported by our solid balance sheet.

Scott Fracs: As of March 31, 2025, cash and cash equivalents, including restricted cash of $11 5 million compared to $11 3 million at December 31, 2024.

Scott Fracs: Shareholders' equity, excluding noncontrolling interests was $24 7 million or $3 82 per outstanding share.

Scott Fracs: Paired with $25 2 million or $3 92 per outstanding share at December 31st 2024.

Scott Fracs: Fully diluted weighted average common shares outstanding.

Scott Fracs: $6 million 592000 for Q1, 2025, and $6 million 576000 for Q1 2024.

Frech Scott: This concludes the formal part of our presentation. Thank you again for joining us today. We look forward to updating you on our progress in the quarters ahead.

Scott Fracs: This concludes the formal part of my presentation. Thank you again for joining US today, we look forward to updating you on our progress in the quarters ahead I'd like to now turn the call back to the operator and open it up for questions.

Operator: I'd like to now turn the call back to the operator and then open it up for questions. Thank you.

Operator: We will now begin the question and answer session. To ask a question, you may press star, then 1 on your touchtone phone. If you are using a speakerphone, please pick up your handset before pressing the keys. To withdraw your question, please press star, then 2. We ask that you please limit yourself to one question and one follow-up. If you have further questions, you may re-enter the question queue.

Scott Fracs: Thank you we will now begin the question and answer session to ask a question you May Press Star then one on your Touchtone phone.

Scott Fracs: If you were using a speakerphone please pick up your handset before pressing the keys.

Scott Fracs: To withdraw your question. Please press Star then two.

Scott Fracs: We ask that you please limit yourself to one question and one follow up for you.

Scott Fracs: Further questions you may reenter the question queue.

M. Miram: Our first question will come from M.

Speaker Change: Our first question will come from Ann Mirror them with sacks. Please go ahead.

Gary Delanois: Miram with Zax. Please go ahead. Thank you. So, in reading through the press release and, you know, thinking about the impact of a lower number of procedures performed, there's been a lot of talk lately in the news about potential changes to some of the regulations around reimbursements. Do you, does the company believe that there could be an impact based on, you know, some of the discussions that we're hearing about right now? And thanks for that question, appreciate it. The changes that are kind of going around in Washington and all are changes to the Medicaid program in particular.

Speaker Change: Thank you Hum.

Speaker Change: We don't kind of a press release and you know thinking about the impact of a.

Speaker Change: A lower number of procedures performed theres been a lot of talk lately in the news about potential changes to some of the.

Speaker Change: Regulations around reimbursement.

Speaker Change: Thank you.

Speaker Change: The company believes that there could be an impact.

Speaker Change: John you know some of the discussions that we're hearing about right now.

Speaker Change: Yeah.

Speaker Change: And thanks for that question I appreciate it.

Speaker Change: The changes that are kind of going around in Washington at all our changes to Medicaid program in particular.

Gary Delanois: And, you know, we're not, we don't feel we're prone to much risk in terms of reimbursing. The rates at which we're reimbursed. But there could be a decrease in respect to Medicaid with the number of people that are covered by the program. And fortunately, we do not have large revenue streams that come from Medicaid. Most of our revenue is coming from private insurers. and the Medicare program and significantly less exposure to the number of patients covered under Medicaid. So we don't feel that there is some degree of risk, but we don't believe that risk is very high.

Speaker Change: And you know we're not we don't feel we're prone too much risk in terms of reimbursements.

Speaker Change: The rates at which were reimbursed.

Speaker Change: But there could be a decrease in respect to Medicaid with the number of people that are covered by program.

Speaker Change: And Fortunately, we do not have large revenue streams that come from Medicaid.

Speaker Change: Most of our revenue is coming from private insurers.

Speaker Change: In the Medicare program and significantly less exposure to the number of patients covered under Medicaid. So we don't feel that there is some degree of risk, but we don't believe that risk is very high.

M. Miram: Okay, and then I get one follow-up question, I believe.

Speaker Change: Okay, and then I got one follow up question I believe.

Gary Delanois: As you look, you know, towards your pipeline of growth initiatives and opening up the new center in Rhode Island, you know, is one of the projects that I think you're, you know, in the process of moving forward. Will you have a little bit more flexibility in terms of managing the fixed cost absorption once there's another center opened in Rhode Island? Yes, we have a very fixed cost business model. And when we have the direct patient services segment that we're expanding into and growing rather significantly, we have much more degree of influence and control over the activities and the relationships and all the things that can make our patients serve, the patients that we serve grow in number.

Speaker Change: As you look towards your pipeline of growth in Asia does end up being.

Speaker Change: The New center in Rhode Island.

Speaker Change: One of the projects that I think you know in the process of moving forward.

Speaker Change: Hmm.

Speaker Change: Well, you will have a little bit more flexibility in terms of managing the fixed cost absorption once theres. Another center opened in Rhode Island.

Speaker Change: Yes, we have a very fixed cost business model.

And when we have that direct patient services segment that we're expanding into and grown rather significantly.

Speaker Change: We have much more degree of influence and control over the activities and the relationships and.

Speaker Change: All the things that can make our patient serve the patients that we serve.

Speaker Change: Growing number.

M. Miram: Okay, thank you.

Speaker Change: Okay. Thank you.

Speaker Change: Yeah.

Operator: At this time, we will pause momentarily to assemble our roster for any further questions. With no further questions, this will conclude our question and answer session.

Speaker Change: At this time, we will pause momentarily to assemble our roster for any further questions.

Speaker Change: Yeah.

Speaker Change: With no further questions. This will conclude our question and answer session I would like to turn the conference back over to Ralph Giacobbe Executive Chairman for any closing remarks.

Raymond Stachowiak: I would like to turn the conference back over to Ray Stachowiak, Executive Chairman, for any closing remarks. Thank you, Wyatt. And thanks. Thank you all for joining us today. We are at a key point in time for our company as we execute on our growth strategy while navigating through some short term fluctuation. We are optimized well and focused on building strong momentum as our growth strategy takes hold. The Rhode Island acquisition was just the first stepping stone and marked a significant milestone for our company. Internationally, our expansion to Mexico further strengthens our position as a leader in specialized radiation therapy services.

Ralph Giacobbe: Thank you Wyatt and thanks. Thank you all for joining US today, we are at a key point in time for our company as we execute on our growth strategy, while navigating through some short term fluctuations.

Ralph Giacobbe: We are optimized well and focused on building strong momentum as our growth strategy takes hold.

Ralph Giacobbe: The Rhode Island acquisition was just the first stepping stone and marked a significant milestone for our company.

Ralph Giacobbe: Internationally, our expansion into Mexico further strengthens our position as a leader in specifies radiation therapy services.

Raymond Stachowiak: We have strong upcoming potential value approaching as detailed early. Our Certificate of Need or CON approval in Rhode Island for a fourth radiation therapy center and our CON to develop and operate the first proton beam radiation therapy facility in Rhode Island represent major long-term opportunities for further advancement. Additionally, the tuck-in acquisitions we're working on will also help bolster our growth opportunity further. We are confident in our strategy and our team's ability to... We look forward to updating you on our continued progress as we drive sustainable growth, profitability, and long-term success. If you have any questions, don't hesitate to reach out.

Ralph Giacobbe: We have strong upcoming potential value approaching as detailed earlier.

Ralph Giacobbe: Our certificates of need or plan approval in Rhode Island for a fourth radiation therapy Center.

Ralph Giacobbe: And our C O N to develop and operate the first proton beam radiation therapy facility and Rhode Island represent major long term opportunity for further expansion.

Ralph Giacobbe: Additionally, the tuck in acquisitions, we're working on will also help bolster our growth opportunity further.

Ralph Giacobbe: We are confident in our strategy and our team's ability to execute.

Ralph Giacobbe: We look forward to updating you on our continued progress as we drive sustainable growth profitability and long term success.

Ralph Giacobbe: If you have any questions don't hesitate to reach out we welcome the conversation.

Raymond Stachowiak: We welcome the conversation. Thanks again for your interest in American Shared Hospital Service. Have a great rest of your day and the rest of the week.

Speaker Change: Thanks again for your interest in American shared hospital services.

Speaker Change: Have a great rest of your day and rest of the week.

Operator: Goodbye.

Speaker Change: Goodbye.

Operator: The conference is now concluded. Thank you for attending today's presentation.

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

Operator: You may now disconnect.

Speaker Change: Okay.

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