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JUNE 14, 2016
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This presentation may be deemed to contain certain forward-looking statements with respect to the
financial condition, results of operations and future plans of American Shared Hospital Services, which
involve risks and uncertainties including, but not limited to, the risks of the Gamma Knife and radiation
therapy businesses, the risks of developing The Operating Room for the 21st Century program, the risks
of investing in Mevion Medical Systems, Inc., and the risks of the timing, financing, and operations of the
Company’s proton therapy business. Further information on potential factors that could affect the financial
condition, results of operations and future plans of American Shared Hospital Services is included in the
filings of the Company with the Securities and Exchange Commission, including the Company's Annual
Report on Form 10-K for the year ended December 31, 2015, Quarterly Report on Form 10-Q for the
quarter ended on March 31, 2016 and the definitive Proxy Statement for the Annual Meeting of
Shareholders to be held on June 21, 2016.
American Shared Hospital Services 2
SAFE HARBOR STATEMENT
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CURRENT OPERATIONS
American Shared Hospital Services 3
BUSINESS OPERATIONS
Radiosurgery 17 Centers
Linear Accelerator Based Radiation Therapy 1 Center
Proton Beam Radiation Therapy 1 Center
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GAMMA KNIFE
+ Gold Standard for
Cranial Radiosurgery
+ Typical Project Cost
$3 - $4 million
American Shared Hospital Services 4
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PROTON
THERAPY
+ Historically, centers
were 3-5 treatment
room centers costing
$150 - $200 million
or more
+ New single room
systems by Mevion
Medical Systems and
others have reduced
the average cost per
treatment rooms to
$25 - $30 million
American Shared Hospital Services
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ASHS - BUSINESS MODEL
American Shared Hospital Services 6
+ Structured as a (alternative) leasing company
+ Innovative financing features not available
from traditional finance companies
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ASHS - BUSINESS MODEL
+ Long Term Agreements
Typically 10 years
+ Revenue Sharing or Fee Per Use
NO MINIMUM VOLUME GUARANTEES
American Shared Hospital Services 7
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ASHS’ RESPONSIBILITIES
+ Acquire equipment
+ Equipment related operating expenses
+ Jointly fund marketing
American Shared Hospital Services 8
ASHS - BUSINESS MODEL
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ASHS - BUSINESS MODEL
HOSPITAL’S RESPONSIBILITIES
+ Site costs
+ Operating costs, excluding those covered
by American Shared
+ Jointly fund marketing
American Shared Hospital Services 9
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GAMMA KNIFE
TREATMENT
INDICATIONS
+ Malignant Brain Tumors
Metastatic Brain Tumors
(180,000 – 200,000
Diagnosed Annually)
+ Benign Brain Tumors
+ Trigeminal Neuralgia
(Facial Pain)
+ Vascular Malformations
American Shared Hospital Services 10
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ASTRO RECOMMENDATION
American Shared Hospital Services 11
“Don’t routinely add adjuvant
whole brain radiation therapy to
stereotactic radiosurgery
for limited brain metastases”
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ASHS - GAMMA
KNIFE PARTNERS
1. Methodist Healthcare System San Antonio, TX
2. Yale-New Haven Hospital New Haven, CT
3. Kettering Medical Center Kettering, OH
4. Tufts Medical Center Boston, MA
5. University of Arkansas for Medical Sciences Little Rock, AR
American Shared Hospital Services 12
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6. JFK Medical Center Edison, NJ
7. Sunrise Hospital and Medical Center Las Vegas, NV
8. Central Mississippi Medical Center Jackson, MS
9. OSF Healthcare Peoria, IL
10. Lovelace Medical Center Albuquerque, NM
11. Northern Westchester Hospital Mt. Kisco, NY
American Shared Hospital Services 13
ASHS - GAMMA
KNIFE PARTNERS
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12. Mercy Health Center Oklahoma City, OK
13. USC University Hospital Los Angeles, CA
14. Fort Sanders Regional Medical Center Knoxville, TN
15. St. Vincent’s Medical Center Jacksonville, FL
16. Sacred Heart Hospital Pensacola, FL
17. PeaceHealth Sacred Heart Hospital Springfield, OR
American Shared Hospital Services 14
ASHS - GAMMA
KNIFE PARTNERS
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1. Tufts Medical Center Boston, MA
American Shared Hospital Services
ASHS RADIATION
THERAPY
PARTNER - LINAC
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ASHS - PROTON BEAM RADIATION THERAPY
American Shared Hospital Services 16
+ NOT A NEW technology
+ Clinically Advantageous
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PROTON THERAPY INDICATIONS TREATED
+ Prostate + Breast
+ Head and Neck + Lymphomas
+ Lung + CNS
+ Liver + Pediatric
+ GI
American Shared Hospital Services 17
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1. The Marjorie and
Leonard Williams
Center for Proton
Therapy at UF Health
Cancer Center -
Orlando Health
ASHS - PROTON
BEAM PARTNERS
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WHAT MAKES PROTON THERAPY SPECIAL
American Shared Hospital Services 19
+ Protons deposit dose at tumor, versus x-rays
passing through the tumor
+ Minimize damage to surrounding tissue
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ASHS - BRAGG PEAK PHENOMENA
American Shared Hospital Services 20
15 MV PHOTONS vs SOBP PROTONS
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ASHS - PHOTON VS. PROTON
American Shared Hospital Services 21
Photon Beam Delivery
Proton Beam Delivery
% Dose
Recommended
100
50
10
PEDIATRIC MEDULLOBLASTOMA
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PBRT CAPTURE RATE 15% 2 30% 3
Number of radiation therapy patients
annually in the U.S.1 995,000 995,000
Percent of radiation therapy patients
eligible for PBRT 15% 30%
Number of potential PBRT patients
in the U.S. 149,250 298,500
Potential PBRT room market* 597 1,194
*Assumed 250 patients treated annually per PBRT room
(1) The American Cancer Society indicates that 1,658,370 people in the United States will be diagnosed with cancer in 2014. Approximately 60% of these
people will receive radiation treatment.
(2) “Number of Patients Potentially Eligible for Proton Therapy,” Acta Oncologica 2005; 44; 836-849; Bengt Glimelius, Anders Ask, Et. Al.
(3) “Evaluation of Potential Proton Therapy Utilization in a Market Based Environment,” Tomas Dvorak, M.D. and David E. Wazer, M.D.
ASHS - UNITED STATES PBRT
MARKET ANALYSIS
American Shared Hospital Services 22
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ASHS - PBRT OPPORTUNITY
American Shared Hospital Services 23
+ Currently only 21 PBRT centers in U.S.
+ 9 PBRT centers under development in U.S.
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ASHS - PROTON
THERAPY
STRATEGY
+ Develop single room
proton beam radiation
therapy centers with
major hospitals
American Shared Hospital Services 24
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PROTON THERAPY MARKET ANALYSIS
+ Current Medicare Reimbursement:
approximately $1,150 per fraction (daily
session). A course of treatment runs
25-30 fractions
+ Established centers treat 20-35 patients
per day, per treatment room
American Shared Hospital Services 25
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PROTON THERAPY MARKET ANALYSIS
+ Utilizes same business model as the
Gamma Knife. Expect margins to be similar
+ For ASHS, each treatment room offers
potential for substantial incremental
revenue and EBITDA
American Shared Hospital Services 26
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ASHS - MANAGEMENT TEAM
American Shared Hospital Services 27
MANAGEMENT TEAM Years of Healthcare
Experience
Ernest A. Bates, M.D. Chairman and CEO
30+
Craig K. Tagawa COO and CFO
30+
Ernest R. Bates V.P. of Sales and Business Development
10+
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ASHS - SUMMATION
American Shared Hospital Services 28
+ Profitable supplier of Gamma Knife
services since 1991
+ Long-standing alliances with premier
cancer centers
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ASHS - SUMMATION
POSITIONED FOR GROWTH IN EMERGING
PROTON THERAPY MARKET
+ Development and financing of Orlando project establishes
ASHS’ proton bona fides
+ First proton therapy center now treating patients
+ Expect modest revenue contribution in June quarter, much
more substantial in second half and beyond
+ Negotiating development of additional proton centers
American Shared Hospital Services 29
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4 Embarcadero Center, Suite 3700
San Francisco, CA 94111
(415) 788-5300
www.ashs.com NYSE MKT:AMS