American Shared Hospital Services           Making the Best Healthcare Technology Accessible   NYSE American: AMS                               December 2019
 Safe Harbor Statement    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 (including statements regarding the expected continued   growth in volume of the MEVION S250 system, the expansion of the Company's   proton therapy business, and the timing of treatments by new Gamma Knife systems)   which involve risks and uncertainties including, but not limited to, the risks of   variability of financial results between quarters, the risks of the Gamma Knife and   radiation therapy businesses, the risks of changes to CMS reimbursement rates or   reimbursement methodology, 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 Reports on Form 10-K,   Quarterly Reports on Form 10-Q and the definitive Proxy Statement for the Annual   Meeting of Shareholders.   NYSE American: AMS                                                 2
 Overview    American   Shared  Hospital  Services  has an  over  30-year  track  record  of leasing    state-of-the-art medical  equipment   to hospitals and  medical  centers in the United    States and abroad.     We  are  the worldwide   leader  in Gamma    Knife  unit ownership   through  our  81%    owned   subsidiary, GK Financing,  LLC (GKF). Our  Gamma    Knife financing model   has    been  expanded  to incorporate  the financing of other technology   solutions including    Intensity Modulated   Radiation Therapy  (IMRT)  and  Proton Beam   Radiation  Therapy    (PBRT).                                    MARKET DATA                     Ticker: NYSE American                                                                           AMS                     Price (12/6/2019)                             $2.55                     52 Week Range                            $2.19 - $3.30                     Market Cap                                   $14.8M                     Average Daily Trading (30 day)               ~15,000                     FD Common Shares Outstanding                      5.9M                     Float                                                                                                         3.7M                     Tangible Book Value per share (9/30/2019)                                    $5.40                     Cash and Equivalents per share (9/30/2019)                                  $0.17 3 NYSE American: AMS
 Investment Highlights   +  Pioneer in single room Proton Beam Radiation Therapy (PBRT) services   +  World leading supplier of Gamma Knife services    +  Long-standing alliances with premier cancer centers   +  Large market opportunities         Proton Therapy has low market penetration        Advanced radiation therapy devices   +  Proven business model          Operating profitability for 20 of last 21 years   +  Respected management team with deep experience  NYSE American: AMS                                                           4
 Respected Management Team With                                    Deep Experience                                          Years of Healthcare       MANAGEMENT TEAM                                           Experience       Ernest A. Bates, M.D.                                             30+      Founder, Chairman and CEO       Craig K. Tagawa                        30+      COO and CFO       Ernest R. Bates                        15+      V.P., Sales and Business Development       Alexis Wallace                         10+      Controller   NYSE American: AMS                                      5
 Highly Regarded Customers*   +  UC San Francisco Medical Center          +  Tufts Medical Center: Boston, MA  +   Methodist Hospital: San Antonio, TX     +  University of Arkansas for Medical Sciences:   +  Johns Hopkins Medical Center: Baltimore, MD Little Rock, AR  +  Yale-New Haven Hospital: New Haven, CT   +  Merit Health Central: Jackson, MS  +  Kettering Medical Center: Kettering, OH                                             +  OSF St. Francis Medical Center: Peoria, IL  +  Lovelace Medical Center: Albuquerque, NM                                             +  PeaceHealth: Eugene: OR +  Northern Westchester Hospital: Mt. Kisco, NY                                              +  USC University Hospital: Los Angeles, CA   * Representative list     NYSE American: AMS                                                           6
 Proven Business Model             + Structured as an alternative leasing company     + Offer Innovative financing features not available from traditional                        finance companies                    + Long Term Agreements                         Typically 10 years                + Revenue Sharing or Fee Per Use                     No minimum volume guarantees   NYSE American: AMS                                      7
 Partner Responsibilities           ASHS’                 HOSPITAL     RESPONSIBILITIES        RESPONSIBILITIES    • Acquire equipment      • Site costs   • Equipment-related      • Non-equipment-related      operating expenses       operating expenses    • Jointly fund marketing • Jointly fund marketing   NYSE American: AMS                               8
 Growing Contribution from                              Proton Therapy     Revenue Summary 2013 – 2019    $ / Millions  $25                  0.6  $20        0.5     1.1          0.4     4.1                     5.0 0.8  $15 0.9                        4.7   $10                13.6         16.1 16.1      14.5       14.8  $5                    10.3   $0     2014 2015 2016 2017 2018 9/30/2019                        YTD           GKF PBRT IGRT  NYSE American: AMS          9
 Proton Beam Radiation Therapy   + Commercial & Profitable:      +  NOT a NEW  Technology   Single room proton beam    radiation therapy centers     +  Clinically Advantageous    +  Significantly reduced average +  Protons deposited dose at tumor,        cost per treatment room to $30   more effective than x-rays passing        - $40M                           through a tumor    +  ASHS provider is Mevion       +  Minimizes damage to surrounding        Medical Systems                  tissue                                 +  Increasing awareness of therapeutic  + Partner: The Marjorie and        benefits across indications   Leonard Williams Center for    Proton Therapy at UF Health   ProstateIndications Treated: Breast   Cancer Center - Orlando Health Head and Neck      Lymphomas                                 Lung                Central Nervous System                                 Liver               Pediatric                                 GI   NYSE American: AMS                                                 10
 Photon vs. Proton       Pediatric Medulloblastoma       Photon Beam Delivery                                               % Dose                                              Recommended        Proton Beam Delivery              PBRT Delivers Improved Dose                     Distribution NYSE American: AMS                                   11
 Large U.S. Market Opportunity        for Additional PBRT Centers  + Currently only 30 PBRT centers* in operation     Capacity of 90 rooms   + Only 4 PBRT centers under construction or in development*   + Only 7% - 14% of required capacity is currently available for     treatment     ASHS projected capacity required to meet demand          635 – 1,270 rooms**    + Each additional treatment room offers potential for substantial     incremental Revenue and EBITDA   *   Source: The National Association for Proton Therapy, 2019  ** Assumes 15% - 30% of 1.1 million patients eligible for radiation therapy annually receive PBRT, see slide 15 NYSE American: AMS                               12
 Low Market Penetration of PBRT          PBRT CAPTURE RATE                                                                                15%      2                     30%     3          Number of radiation therapy patients annually                                                                                                      1,057,470                      1,057,470         in the U.S.1          Percent of radiation therapy patients                                                                                                                15%                            30%         eligible for PBRT          Number of potential PBRT patients                                                                                                          158,600                       317,241         in the U.S.          Potential PBRT room market*                                                                             635                        1,270          Current PBRT rooms in operation4                                                                          90    *Assumed 250 patients treated annually per PBRT room  (1) The American Cancer Society indicates that 1,762,450 people in the United States will be diagnosed with cancer in 2019. 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.   (4) The National Association for Proton Therapy, 2019 NYSE American: AMS                                                                                                                                      13
 Exploring Expansion Opportunities    + Developing single and      two room proton beam      radiation therapy      centers with major      hospitals    + MR Guided Linac    + Community Hospitals    + International       + Latin America initially   NYSE American: AMS                               14
 Gamma Knife Radiosurgery                               Equipment  +  World’s leading supplier       U.S. market share ~13%    +  Gold standard equipment for cranial radiosurgery        Non-invasive alternative to surgery for malignant and benign brain tumors,        vascular malformations and trigeminal neuralgia (facial pain)   +  Typically improves patient quality of life both during and after treatment       Usually performed as an outpatient procedure       Virtually pain-free        Typically no anesthesia        Minimal side effects        Patients typically return to pre-surgery activities within                                        several days   +  Typical project cost - $3 - 4 million  NYSE American: AMS                                                 15
 Current Business Status    + Identifying healthcare technology investment opportunities     with long term growth potential    + Negotiations continuing for 2 additional PBRT installations   + Gamma Knife     Completed first Icon upgrade     Anticipate additional Icon upgrades in 2020   + Identifying additional international                               opportunities   NYSE American: AMS                               16
 American Shared Hospital Services      Making the Best Healthcare Technology Accessible                                For Further Information Contact:                                  Craig Tagawa     Thank You!                  COO and CFO                               ctagawa@ashs.com                                 (415) 788-5300    NYSE American: AMS            www.ashs.com           17