American Shared Hospital Services (AMEX:AMS) Q4 2022 Earnings Call Transcript

So at $8 million a year, you’re basically at 2x cash flow from operations, 2×8 $16 million versus $17 million in market cap. I mean this is fascinating. It’s better than 2.4x cash flow from operations. And so essentially, if you even had an 8x multiple on that $8 million for a steady state company, the company should be at a $64 million market cap. And, according to your vision, if you grow, and the market loves medical companies at a 15x multiple, your market cap would be at $120 million, if you were growing at double digits. So I just wanted to get conceptual agreement on what the stakes are here? And so it seems like this situation is ripe for M&A. You mentioned correctly so that the cash on the balance sheet gives you a lot of optionality, certainly gives you about $100 million in buying power for more advanced radiological equipment.

So here’s my #1 question. How do you view strategically as a company the psychology of making a sale, let’s say, the long beach situation to a group of doctors in private practice, the associated risks with which you’re very good at building out a proton therapy room, versus, let’s say, some hospitals, which, as you know, all the time, they need to get cash. And doing a sale and leaseback agreement where an existing hospital with existing cash flow from operations that could be easily quantified essentially buying a controlling or a minority stake in a sale and leaseback sort of situation or just taking an outright minority stake for the hospital to free up cash? How do you view those two different sales cycles strategically?

Raymond Stachowiak: Let’s — we are probably not inclined to approach health care systems and pursuing sale leaseback situations. When you do such, you’re really talking money over money financing, and we believe that our company offers much more value added than that type of capability. So we are going to pursue that path to providing radiation oncology equipment, it’s a very capital intensive proposition for health care systems. And they’re trying — inevitably, as an example, any health care — major health care system, as an example, might have $100 million of requests for capital expenditure coming through the financial officer’s desk each year, and they only have $25 million of capital to allocate. So where do they invest?

And in partnership with American Shared, we can expand that capital budget so that they can enter the marketplace through this high tech technology much faster than the competition and remain competitive and a leader in cancer treatment within the respective service area. Does that make sense?

Unidentified Analyst: It makes total sense. And I apologize for asking a similar question in a slightly different way, but have you ever considered, rather than controlling the proton beam therapy center, taking minority stakes, 20% to 40% might be more geographically diversified and just diversified in terms of centers without having to have that huge outlay of, let’s say, $100 million or $150 million, et cetera?

Raymond Stachowiak: If the situation calls for that, and that’s what meets the customer’s needs, I’d say, yes, we would be very open to those type of situations.

Unidentified Analyst: Because what’s fascinating here mathematically is, let’s say you’re growing at 30% to 50%, either 47 point something depending on further data or closer to 30 something in proton beam therapy. Just mathematically, there’s a point where essentially the growth of the proton beam therapy is so great that it overtakes the decrease in business domestically, the decrease in Gamma Knife. But of course, you are limited to the center in Orlando. But it just seems like the optionality, the embedded optionality on your balance sheet, let’s say, I estimate $14 million, $15 million in cash on unrestricted cash on the balance sheet, it’s just amazing that optionality. So I’m going to let someone else ask a question. But before I go, could you give us a little bit of color on — it seems like the mix of payers, or commercial payers has really improved the cash flow from proton beam therapy.