EHSI 10-Q Quarterly Report Sept. 30, 2015 | Alphaminr
Elite Health Systems Inc.
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EHSI 10-Q Quarter ended Sept. 30, 2015

Balance Sheet
Cash Flow
Income Statement
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PROXIES
DEF 14A
Filed on Oct. 31, 2025
10-Q 1 form10q.htm U.S. NEUROSURGICAL HOLDINGS, INC 10-Q 9-30-2015
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM 10-Q

☒
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended September 30, 2015
or
☐
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT
For the transition period from                     to                     .

Commission file number:  0-15586

U.S. Neurosurgical Holdings, Inc.
(Exact name of registrant as specified in its charter)

Delaware
47-5370333
(State of other jurisdiction of incorporation or organization)
(I.R.S. Employer Identification No.)

2400 Research Blvd, Suite 325, Rockville, Maryland 20850
(Address of principal executive offices)

(301) 208-8998
(Registrant's telephone number)

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Exchange Act during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (Section 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). Yes ☒ No ☐
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company.  See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer ☐
Accelerated filer ☐
Non-accelerated filer ☐
Smaller reporting company ☒

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒
The number of shares of the registrant’s common stock, $0.01 par value, outstanding as of November 13, 2015 was 7,797,185.
TABLE OF CONTENTS

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23
PART I - FINANCIAL INFORMATION

Item 1.
Financial Statements

U.S. NEUROSURGICAL HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS

September 30,
2015
December 31,
2014
(UNAUDITED)
ASSETS
Current assets:
Cash and cash equivalents
$
1,070,000
$
1,053,000
Accounts receivable
142,000
277,000
Due from related parties
53,000
8,000
Elekta refund due
-
115,000
Deferred tax asset
11,000
-
Short term loan receivable
35,000
-
Other current assets
60,000
72,000
Total current assets
1,371,000
1,525,000
Notes receivable
210,000
-
Investments in unconsolidated entities
428,000
323,000
Total other assets
638,000
323,000
Gamma knife (net of accumulated depreciation of $941,000 in 2015 and $475,000 in 2014)
3,450,000
3,960,000
Leasehold improvements (net of accumulated amortization of $432,000 in 2015 and $197,000 in 2014)
1,748,000
1,643,000
5,198,000
5,603,000
TOTAL ASSETS
$
7,207,000
$
7,451,000
LIABILITIES
Current liabilities:
Obligations under capital lease - current portion
$
818,000
$
821,000
Deferred tax liability- current portion
-
92,000
Accounts payable and accrued expenses
109,000
96,000
Deferred revenue
112,000
48,000
Due to related parties
13,000
13,000
Total current liabilities
1,052,000
1,070,000
Obligations under capital lease - net of current portion
3,144,000
3,838,000
Deferred tax liability - net of current portion
373,000
150,000
Guarantee liability
15,000
-
Asset retirement obligations
460,000
431,000
Total liabilities
5,044,000
5,489,000
Commitments and contingencies
STOCKHOLDERS’ EQUITY
Common stock - par value $.01; 25,000,000 shares authorized; 7,797,185 shares issued and outstanding at September 30, 2015 and December 31, 2014.
78,000
78,000
Additional paid-in capital
3,100,000
3,100,000
Accumulated deficit
(1,015,000
)
(1,216,000
)
Total stockholders' equity
2,163,000
1,962,000
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY
$
7,207,000
$
7,451,000

The accompanying notes to condensed consolidated financial statements are an integral part hereof.
U.S. NEUROSURGICAL HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(UNAUDITED)

Three Months Ended
September 30,
2015
2014
Revenue
$
772,000
$
1,016,000
Costs and expenses:
Patient expenses
314,000
203,000
Selling, general and administrative
291,000
308,000
Total
605,000
511,000
Operating income
167,000
505,000
Interest expense
(47,000
)
(73,000
)
Other expense
(13,000
)
-
Income from investments in unconsolidated entities
36,000
8,000
Income before income taxes
143,000
440,000
Provision for income tax expense
(53,000
)
(170,000
)
Net income
$
90,000
$
270,000
Basic and diluted net income per share
$
0.01
$
0.03
Weighted average common shares outstanding
7,797,185
7,797,185

The accompanying notes to condensed consolidated financial statements are an integral part hereof.
U.S. NEUROSURGICAL HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(UNAUDITED)

Nine Months Ended
September 30,
2015
2014
Revenue
$
2,253,000
$
1,753,000
Costs and expenses:
Patient expenses
875,000
407,000
Selling, general and administrative
958,000
876,000
Total
1,833,000
1,283,000
Operating income
420,000
470,000
Interest expense
(137,000
)
(138,000
)
Gain from sales of investments in unconsolidated entities
-
238,000
Other income
13,000
-
Income (loss) from investments in unconsolidated entities
25,000
(4,000
)
.
Income before income taxes
321,000
566,000
Provision for income tax expense
(120,000
)
(170,000
)
Net income
$
201,000
$
396,000
Basic and diluted net income per share
$
0.03
$
0.05
Weighted average common shares outstanding
7,797,185
7,797,185

The accompanying notes to condensed consolidated financial statements are an integral part hereof.
U.S. NEUROSURGICAL HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)

Nine Months Ended
September 30,
2015
2014
Cash flows from operating activities:
Net income
$
201,000
$
396,000
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Depreciation and amortization
701,000
400,000
(Income) loss from investments in unconsolidated entities
(25,000
)
4,000
Gain from sale of investments in unconsolidated entities
-
(238,000
)
Accretion of asset retirement obligations
29,000
-
Accrued interest from capital lease obligations
-
83,000
Deferred income taxes
120,000
170,000
Changes in:
Accounts receivable
135,000
(687,000
)
Elekta refund due
115,000
-
Other current assets
12,000
(49,000
)
Accounts payable and accrued expenses
13,000
(99,000
)
Deferred revenue
64,000
-
Net cash provided by (used in) operating activities
1,365,000
(20,000
)
Cash flows from investing activities:
Proceeeds from sale of investments
-
256,000
Advances -  short term receivable and note receivable
(245,000
)
-
Purchase of leasehold improvements
(341,000
)
(689,000
)
Investment in unconsolidated entity
(7,000
)
-
(Increase in) decrease of due from related parties
(103,000
)
297,000
Net cash used in investing activities
(696,000
)
(136,000
)
Cash flows from financing activities:
Repayment of capital lease obligations
(652,000
)
(116,000
)
Repayment of short-term loans
-
(262,000
)
Proceeds from short-term loans
-
462,000
Net cash (used in) provided by financing activities
(652,000
)
84,000
Net change in cash and cash equivalents
17,000
(72,000
)
Cash and cash equivalents - beginning of period
1,053,000
1,414,000
Cash and cash equivalents - end of period
$
1,070,000
$
1,342,000
Supplemental disclosures of cash flow information:
Cash paid for interest
$
159,000
$
52,000
Supplemental disclosure of of noncash investing and financing activities:
Increase in investment in unconsolidated entities through recording of guarantee liability
$
25,000
$
-
Increase in guarantee liability recorded
$
15,000
$
-
Purchase of gamma knife and related leasehold improvements through captial lease obligation
$
-
$
4,297,000
Increase in fixed assets due to capitalization of asset retirement obligations
$
-
$
431,000
Purchase of gamma knife included in accounts payable
$
-
$
181,000

The accompanying notes to condensed consolidated financial statements are an integral part hereof.
U.S. NEUROSURGICAL HOLDINGS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

Note A - Basis of Preparation

The accompanying condensed consolidated financial statements of U.S. Neurosurgical Holdings, Inc. and subsidiaries (the “Company”) as of September 30, 2015 and 2014, are unaudited.  However, in the opinion of management, such statements include all adjustments necessary for a fair statement of the information presented therein.  The balance sheet at December 31, 2014 has been derived from the audited financial statements at that date appearing in the Company's Annual Report on Form 10-K.

Pursuant to accounting requirements of the Securities and Exchange Commission applicable to quarterly reports on Form 10-Q, the accompanying condensed consolidated financial statements and notes do not include all disclosures required by accounting principles generally accepted in the United States of America for complete financial statements.  Accordingly, these statements should be read in conjunction with the Company's most recent annual financial statements.

Consolidated results of operations for interim periods are not necessarily indicative of those to be achieved for full fiscal years.

Note B – Holding Company Structure

On September 3, 2015, pursuant to the Agreement and Plan of Reorganization (the “ Merger Agreement ”), dated as of September 3, 2015, by and among U.S. NeuroSurgical, Inc. (“USN”), U.S. NeuroSurgical Holdings, Inc. (“Holdings”) and U.S. NeuroSurgical Merger Sub, Inc. (“ Merger Sub ”), the Company adopted a new holding company organizational structure whereby USN is now a wholly owned subsidiary of Holdings. This structure did not result in any changes to the assets or operations of the Company, but management believes that it will create a more flexible framework for possible future transactions and organizational and operational adjustments.

The holding company organizational structure was effected by a merger (the “ Merger ”) conducted pursuant to Section 251(g) of the Delaware General Corporation Law (the “ DGCL ”), which provides for the formation of a holding company structure without a vote of the stockholders of the constituent corporations.  Because the holding company organizational structure occurred at the parent company level, the remainder of the Company’s subsidiaries, operations and customers were not be affected by this transaction.

In order to effect the Merger, USN formed Holdings as its wholly owned subsidiary and Holdings formed Merger Sub as its wholly owned subsidiary.  Under the terms of the Merger Agreement, Merger Sub merged with and into USN, with USN surviving the merger and becoming a direct, wholly owned subsidiary of Holdings.   Immediately prior to the Merger, Holdings had no assets, liabilities or operations.
Pursuant to the Merger Agreement, all of the outstanding capital stock of USN was converted, on a share for share basis, into capital stock of Holdings.  As a result, each former stockholder of USN became the owner of an identical number of shares of capital stock of Holdings, evidencing the same proportional interests in Holdings and having the same designations, rights, powers and preferences, qualifications, limitations and restrictions, as those that the stockholder held in USN.

Following the Merger, Holdings’ common stock continued to trade on the over-the-counter market and continued to be quoted on the OTCQB marketplace under the same symbol, “USNU.”  The conversion of shares of capital stock under the Merger Agreement occurred without an exchange of physical certificates.  Accordingly, physical certificates formerly representing shares of outstanding capital stock of USN are deemed to represent the same number of shares of capital stock of Holdings.

Pursuant to Section 251(g) of the DGCL, the provisions of the certificate of incorporation and bylaws of Holdings are substantially identical to those of USN prior to the date on which the Merger Agreement took effect.  The authorized capital stock of Holdings, the designations, rights, powers and preferences of such capital stock, and the qualifications, limitations and restrictions thereof are also substantially identical to those of the capital stock of USN immediately prior to the date of the Merger.  Further, the directors and executive officers of Holdings are the same individuals who were directors and executive officers, respectively, of USN immediately prior to the date of the Merger.

Note C – Destruction of Gamma Knife at NYU Medical Center; Replacement and Restoration

USN opened its New York gamma knife treatment center in July 1997 on the campus of New York University (“NYU”) Medical Center.  USN installed a new Leksell gamma knife, the PERFEXION model, at the NYU Medical Center in March 2009 in replacement of the older gamma knife equipment.  In connection with this upgrade, USN modified its arrangement with NYU to extend the term for 12 years from March 2009.

In October 2012, USN’s facility at NYU was totally destroyed as a result of flooding from Hurricane Sandy. The gamma knife had to be removed to prevent any cobalt leakage that might occur due to rusting of the equipment. The removal cost was $525,000. USN paid a lease settlement of the outstanding principal balance only and received from insurance coverage $930,000 above the lease principal payments and removal costs.

USN finalized arrangements with NYU regarding the restored gamma knife center and USN’s long term contract with NYU in early 2014. USN’s new facility, with the Leksell PERFEXION gamma knife, is located in the Tisch Hospital of NYU Langone Medical Center. The facility reopened and began receiving patients at the end of April 2014.
USN entered into a six year lease in the amount of $4.7 million for the purchase of the replacement equipment and associated leasehold improvements. The first payment of $78,000 was made on September 1, 2014, including $18,000 of interest, and the final payment is due on May 1, 2020. USN entered into a second two year lease in the amount of $250,000 for the cost of the construction required at the relocated site. The first payment of $12,000 was made on November 1, 2014, and the final payment is due on July 1, 2016.

The major terms of the agreement with NYU continue in effect, terminating at the end of March 2021.  USN is responsible for the maintenance and insurance for the gamma knife equipment at the NYU facility and is reimbursed for use of the gamma knife based on a fee per procedure performed with the equipment.  NYU provides the medical and technical staff to operate the facility.  At the end of the contract term, costs associated with closing and restoring the NYU facility to its original condition are the responsibility of USN.

Note D – The Southern California Regional Gamma Knife Center

During 2007, the Company managed the formation of the Southern California Regional Gamma Knife Center at San Antonio Regional Hospital (“SARH”) in Upland, California.  The Company participates in the ownership and operation of the center through its wholly-owned subsidiary USN Corona, Inc. (“USNC”).  Corona Gamma Knife, LLC (“CGK”) is party to a 14-year agreement with SACH to renovate space in the hospital and install and operate a Leksell PERFEXION gamma knife.  CGK leased the gamma knife from NeuroPartners LLC, which holds the gamma knife equipment.  In addition to returns on its ownership interests, USNC expects to receive fees for management services relating to the facility.

USNC is a 20% owner of NeuroPartners LLC and owns 39% of CGK.

USNC is a 20% guarantor on NeuroPartners LLC’s seven-year lease with respect to the gamma knife equipment and certain leasehold improvements at SARH.  The outstanding balance on the lease obligations was $1,148,000 at September 30, 2015.  In 2016, NeuroPartners LLC has the option to purchase the gamma knife for $490,000. The Company expects any potential obligations from these guarantees would be reduced by the recoveries of the respective collateral and has recorded a liability of $2,000 associated with this guarantee at September 30, 2015.

Construction of the SARH gamma knife center was completed in December 2008 and the first patient was treated in January 2009.  The project has been funded principally by outside investors.  While the Company has led the effort in organizing the business and overseeing the development and operation of the SARH center, its investment to date in the SARH center has been minimal.
The Company’s share of cumulative losses associated with its investment in NeuroPartners LLC and CGK has exceeded its investment.  Due to the outstanding loans made to NeuroPartners LLC and CGK, NeuroPartners LLC and CGK are considered to be variable interest entities of the Company.  However, as the Company is not deemed to be the primary beneficiary of NeuroPartners LLC and CGK, since it does not have the power to direct the operating activities that most significantly affect NeuroPartners LLC’s and CGK’s economic performance, certain disclosures are required rather than consolidation.  During the nine months ended September 30, 2015, the Company absorbed losses against the total outstanding receivables of $58,000 from NeuroPartners LLC and CGK. For the nine months ended September 30, 2015, the Company’s equity in loss of NeuroPartners LLC and CGK was $78,000.

The following tables present the aggregation of summarized financial information of NeuroPartners LLC and CGK:

Neuro Partners, LLC and CGK Condensed Income Statement Information

Nine Months Ended
September 30,
2015
2014
Patient revenue
$
683,000
$
986,000
Net  (loss) income
$
(153,000
)
$
92,000
USNC's equity in (loss) income of Neuro Partners, LLC and CGK
$
(78,000
)
$
26,000

Three Months Ended
September 30,
2015
2014
Patient revenue
$
185,000
$
424,000
Net (loss) income
$
(84,000
)
$
117,000
USNC's equity in (loss) income of Neuro Partners, LLC and CGK
$
(39,000
)
$
44,000

NeuroPartners, LLC and CGK Condensed Balance Sheet Information

September 30,
2015
December 31,
2014
Current assets
$
156,000
$
92,000
Noncurrent assets
515,000
991,000
Total assets
$
671,000
$
1,083,000
Current liabilities
$
1,223,000
$
829,000
Noncurrent liabilities
316,000
969,000
Equity
(868,000
)
(715,000
)
Total liabilities and equity
$
671,000
$
1,083,000
Note E – Florida Oncology Partners

During the quarter ended September 30, 2010, the Company participated in the formation of Florida Oncology Partners, LLC (“FOP”) and Florida Oncology Partners RE, LLC (“FOPRE”), which operates a cancer center located in West Kendall (Miami), Florida.  The center diagnoses and treats patients utilizing a Varian Rapid Arc linear accelerator and a GE CT scanner. USNC originally invested $200,000 for 20% ownership interest in FOP and FOPRE. The remaining 80% is owned by other outside investors. In January of 2015, one of the investors was removed from the entities, and his ownership interest was distributed among the remaining members in relationship to the percentage they owned. This distribution resulted in an increase of ownership interest for the Company of 4% in each entity. As of January 1, 2015, the Company has a 24% ownership in both FOP and FOPRE.

The center opened and treated its first patient in May 2011. During 2012 and 2013, FOP made several distributions that reduced the Company’s investment significantly.  The Company’s recorded investment in FOP and FOPRE is $291,000 and $190,000 at September 30, 2015 and December 31, 2014, respectively. Amounts due from FOP and FOPRE included in due from related parties total $53,000 and $8,000 at September 30, 2015 and December 31, 2014 respectively.

During 2011, Florida Oncology Partners, LLC entered into a seven year capital lease with Key Bank for approximately $5,800,000. Under the terms of the capital lease, USN agreed to guarantee a maximum of $1,433,000, approximately 25% of the original lease obligation in the event of default. It is a guarantor jointly with most of the other members (except USNC who is not a named guarantor) of FOP.  The outstanding balance on the lease obligation was $2,734,000 at September 30, 2015. The Company expects any potential obligations from this guarantee would be reduced by the recoveries of the respective collateral and has recorded a liability of $13,000 associated with this guarantee at September 30, 2015.

In June 2012, FOPRE completed the financing agreement to purchase the building that is occupied by FOP.  The amount of the loan was $1,534,000 to be paid at a monthly rate of approximately $8,500 for 120 months with the final payment due on June 15, 2022.  USNC is the guarantor of 20% of the outstanding balance of this loan, which was $1,416,000 at September 30, 2015. The Company expects any potential obligations from these guarantees would be reduced by the recovery of the real estate collateral and expects any amounts arising from this guarantee to be insignificant.
The following tables present the aggregation of summarized financial information of FOP and FOPRE:

FOP and FOPRE Condensed Income Statement Information

Nine Months Ended
September 30,
2015
2014
Patient revenue
$
2,074,000
$
1,908,000
Net income
$
310,000
$
90,000
USNC's equity in income of FOP and FOPRE
$
75,000
$
18,000

Three Months Ended
September 30,
2015
2014
Patient revenue
$
811,000
$
673,000
Net income
$
157,000
$
42,000
USNC's equity in income of FOP and FOPRE
$
38,000
$
8,000

FOP and FOPRE Condensed Balance Sheet Information
September 30,
2015
December 31,
2014
Current assets
$
732,000
$
606,000
Noncurrent assets
4,708,000
5,070,000
Total assets
$
5,440,000
$
5,676,000
Current liabilities
$
1,660,000
$
858,000
Noncurrent liabilities
2,651,000
3,947,000
Equity
1,129,000
871,000
Total liabilities and equity
$
5,440,000
$
5,676,000
Note F – Boca Oncology Partners

During the quarter ended June 30, 2011, the Company participated in the formation of Boca Oncology Partners, LLC (“BOP”), for the purpose of owning and operating a cancer center in Boca Raton, Florida.  In June 2011, Boca Oncology Partners RE, LLC (“BOPRE”), an affiliated entity, purchased a 20% interest in Boca West IMP, LLC (“Boca West IMP”), owner of a medical office building in West Boca, Florida in which BOP operates.  BOP occupies approximately 6,000 square feet of the 32,000 square foot building.  The Company’s wholly-owned subsidiary, USNC invested $225,000 initially and had a 22.5% interest in BOP and BOPRE.

In January 2012, an additional investor purchased 50% of the partnership reducing the Company’s ownership to 11.25%.  The Company loaned the proceeds of $56,250 back to BOP as a 5 year note at 7% interest. The remaining 88.75% was owned by other outside investors.  In June 2012, BOPRE purchased an additional 3.75% of Boca West IMP from another investor bringing its total interest to 23.75%. BOPRE accounts for this investment under the cost method since it does not exercise significant influence over Boca West IMP. Then the members of BOPRE sold 31.5% of their interests in BOPRE to a new investor. The proceeds of $28,000 were loaned to BOP and USNC’s investment in BOPRE was reduced to 15.4%.

Although the Company reduced its investment to 11.25% of BOP and 15.4% of BOPRE, the Company continues to account for these investments under the equity method due to its participation in the management of the administration and accounting functions of BOP and BOPRE. Due to the outstanding loans made to BOP, BOP was considered to be a variable interest entity of the Company.  However, as the Company was not deemed to be the primary beneficiary of BOP, since it did not have the power to direct the operating activities that most significantly affect BOP’s economic performance, certain disclosures are required rather than consolidation.  The center opened in August 2012.

In February 2014, the Company and other members sold their interests in BOP.

The Company’s recorded investment in BOPRE is $137,000 and $133,000 at September 30, 2015 and December 31, 2014.

USNC is a 10% guarantor on 50% of the outstanding balance of Boca West IMP’s ten-year mortgage.  This mortgage had an original balance of $3,000,000 and is secured by the medical office building in which BOP operates. The outstanding balance on the mortgage is $2,656,000 at September 30, 2015.  The Company expects any potential obligations from this guarantee would be reduced by the recovery of the real estate and expects any amounts arising from this guarantee to be insignificant.

USNC was a 14.06% guarantor on BOP’s five-year lease with respect to the oncology equipment at the Boca Raton, Florida cancer center. Upon the sale of BOP, which occurred in 2014, USNC was indemnified by the buyer from any losses arising from the guarantee.
The following tables present the summarized financial information of BOPRE:

BOPRE Condensed Income Statement Information

Nine Months Ended
September 30,
2015
2014
Rental Income
$
-
$
-
Net loss
$
(2,000
)
$
(3,000
)
USNC's equity in income in BOPRE
$
-
$
-

Three Months Ended
September 30,
2015
2014
Rental Income
$
-
$
-
Net loss
$
(1,000
)
$
(3,000
)
USNC's equity in income in BOPRE
$
-
$
-

BOPRE Condensed Balance Sheet Information

September 30,
2015
December 31,
2014
Current assets
$
37,000
$
61,000
Noncurrent assets
837,000
786,000
Total assets
$
874,000
$
847,000
Current liabilities
$
-
$
-
Noncurrent liabilities
-
-
Equity
874,000
847,000
Total liabilities and equity
$
874,000
$
847,000
NoteG – Broward Oncology Partners

In early 2013, the Company formed Broward Oncology Partners, LLC (“BROP”) with other outside investors. The Company invested $50,000 for a 12.5% ownership interest in BROP.  BROP operates a radiation oncology center in Fort Lauderdale, Florida under a lease from Tenet Health Services. BROP began operations in February 2013.  In May 2014, the Company and other members sold their interests in BROP.

Note H – Income Taxes

The Company’s income tax rate, which includes federal and state income taxes, was approximately 37%, for the three and nine months ended September 30, 2015. The Company recorded a tax charge of $120,000 for the nine months ended September 30, 2015.
Item 2.
Management Discussion and Analysis of Financial Condition and Results of Operations.

Critical Accounting Policies

The condensed consolidated financial statements of U.S. Neurosurgical Holdings, Inc. and subsidiaries (the “Company”) have been prepared in accordance with accounting principles generally accepted in the United States of America.  As such, some accounting policies have a significant impact on amounts reported in the condensed consolidated financial statements.  A summary of those significant accounting policies can be found in Note B to the Consolidated Financial Statements, in our 2014 Annual Report on Form 10-K.  In particular, judgment is used in areas such as determining and assessing possible asset impairments and determination of the asset retirement obligation.

The following discussion and analysis provides information which the Company’s management believes is relevant to an assessment and understanding of the Company’s results of operations and financial condition. This discussion should be read in conjunction with the condensed consolidated financial statements and notes thereto appearing elsewhere herein.

Results of Operation

Three Months Ended September 30, 2015 Compared to Three Months Ended September 30, 2014

Patient revenue for the three months ended September 30, 2015 was $772,000, a decrease of 24% compared to $1,016,000 the previous year. This decrease in revenue was due to a new reimbursement agreement with NYU. Patient expenses for the three months ended September 30, 2015 were $314,000, an increase of 55% as compared to the $203,000 reported for the comparable period in the previous year. This increase in patient expenses was largely due to increased depreciation and a new maintenance agreement, which went into effect as of April 1, 2015. The first year of maintenance was included in the installation of the equipment.
Selling, general and administrative expense of $291,000 for the third quarter of 2015 was 6% lower than the $308,000 incurred during the comparable period in 2014.  The decrease in SG&A expenses was mostly due to lower legal fees, in the third quarter of 2015 compared to the same period the previous year.

The Company incurred $47,000 of interest expense in the third quarter of 2015 related to the capital lease. Interest expense for the same period in 2014 was $73,000. The lower interest expense in 2015 is primarily due to the repayment of a construction loan balance in late 2014.

During the three months ended September 30, 2015, the Company recognized an income tax charge of $53,000. The 2015 tax expense is due to the Company commencing operations at NYU during 2014, and reducing net operating losses from prior years.  In 2014, the Company had recorded a valuation allowance against certain deferred tax assets.

For the three months ended September 30, 2015, the Company reported a net income of $90,000 as compared to a net income of $270,000 for the same period a year earlier. The lower net income is primarily due to lower revenue as a result of the revised operating agreement with NYU.

Nine months ended September 30, 2015 Compared to nine months ended September 30, 2014

Patient revenue for the nine months ended September 30, 2015 was $2,253,000 an increase of 29% compared to $1,753,000 for the comparable period in the previous year. The increase in revenue is due to the fact that the center was not open during the first quarter of 2014. Patient expenses for the nine months ended September 30, 2015 were $875,000, an increase of 115% as compared to $407,000 reported for the same period a year earlier. This increase in expenses is largely due to the center not being open during the first quarter of the prior year.

Selling, general and administrative expense of $958,000 for the nine months ended September 30, 2015 was 9% higher than the $876,000 incurred during the comparable period in 2014.  The increase in SG&A expenses was mostly due to higher insurance expenses including a new flood policy and reinstated liability policy due to the reopening of the center.

The Company incurred $137,000 of interest expense in the first nine months of 2015 related to the new capital lease. Interest expense for the same period in 2014 was $138,000. During the second quarter of 2015, the leasing company amended the loan documents to correct an overstatement of interest previously charged. Overall, however, interest expense was similar to the same period a year earlier.
During the nine months ended September 30, 2015, the Company recognized an income tax charge of $120,000. The 2015 tax expense is due to the Company commencing operations at NYU during 2014 and reducing net operating losses from prior years.  In 2014, the Company had recorded a valuation allowance against certain deferred tax assets.

For the nine months ended September 30, 2015, the Company reported a net income of $201,000 as compared to a net income of $396,000 for the same period a year earlier.

Liquidity and Capital Resources

At September 30, 2015, the Company had working capital of $319,000 as compared to $455,000 at December 31, 2014.  This decrease was primarily due to a lower accounts receivable balance at September 30, 2015, due to lower monthly billings. Cash and cash equivalents at September 30, 2015 were $1,070,000 as compared to $1,053,000 at December 31, 2014.

With respect to the notes receivable of $210,000 at September 30, 2015, the Company has been in discussions with one of the borrowers regarding the possible future conversion of one of the notes in the principal amount of $172,500 into an equity interest in a future business activity.  As a result, that note receivable has been classified as a non-current asset.

Net cash provided by operating activities for the nine months ended September 30, 2015 was $1,365,000 as compared to $20,000 used in operating activities in the same period a year earlier. The increase was primarily due to cash inflows from the operation of the new gamma knife center, net of working capital requirements. Accounts receivable decreased $135,000 for the nine months ended September 30, 2015 as compared to an increase the previous year due to the reopening of the NYU gamma knife facility.

With respect to financing activities, the Company paid $652,000 towards its capital lease obligations during the first nine months of 2015, compared with $116,000 in 2015 and net borrowings from short-term loans of $200,000 in the same period a year earlier.

USN entered into a six year lease in the amount of $4.7 million for the purchase of the replacement Leksell PERFXION gamma knife at the NYU Medical Center. The first payment of $78,000 was made on September 1, 2014, and the final payment is due on May 1, 2020. USN entered into a second two year lease in the amount of $250,000 for the cost of the construction required at the relocated site. The first payment of $12,000 was made on November 1, 2014, and the final payment is due on July 1, 2016. The agreement with NYU to operate the gamma knife facility continues through March 2021.
Risk Factors

We desire to take advantage of the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995.  The following factors, as well as the factors listed under the caption “Risk Factors” in Annual Report on our Form 10-K for the fiscal year ended December 31, 2014, have affected or could affect our actual results and could cause such results to differ materially from those expressed in any forward-looking statements made by us.  Investors should carefully consider these risks and speculative factors inherent in and affecting our business and an investment in our common stock.

Reliance on Business of the New York University Gamma Knife Center; Recent Destruction of Equipment and Discontinuation of Business at NYU . While it is the Company’s objective to expand activities to additional cancer centers that rely on a broad range of diagnostic and radiation treatments, the Company has relied on the NYU gamma knife for substantially all of its revenue.  In recent periods, services provided at NYU have represented over 90% of the Company’s revenues.  Unless and until the Company is successful in building its activities at other centers and at new locations, disruptions at NYU could have a materially adverse effect on the Company.

Availability of Working Capital . To date, we have earned sufficient income from operations to fund periodic operating losses and support efforts to pursue new gamma knife or other types of cancer treatment centers.

Disclosure Regarding Forward Looking Statements

The Securities and Exchange Commission encourages companies to disclose forward looking information so that investors can better understand a company's future prospects and make informed investment decisions.  This document contains such "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995, particularly statements anticipating future growth in revenues and cash flow.  Words such as "anticipates," "estimates," "expects," "projects," "targets," "intends," "plans," "believes," "will be," "will continue," "will likely result," and words and terms of similar substance used in connection with any discussion of future operating or financial performance identify such forward-looking statements.  Those forward-looking statements are based on management's present expectations about future events.  As with any projection or forecast, they are inherently susceptible to uncertainty and changes in circumstances, and the Company is under no obligation to (and expressly disclaims any such obligation to) update or alter its forward-looking statements whether as a result of such changes, new information, future events or otherwise.

The Company operates in a highly competitive and rapidly changing environment and in businesses that are dependent on our ability to: achieve profitability; increase revenues; sustain our current level of operations; maintain satisfactory relations with business partners; attract and retain key personnel; maintain and expand our strategic alliances; and protect our intellectual property.  The Company's actual results could differ materially from management's expectations because of changes in such factors.  New risk factors can arise and it is not possible for management to predict all such risk factors, nor can it assess the impact of all such risk factors on the Company's business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements.  Given these risks and uncertainties, investors should not place undue reliance on forward-looking statements as a prediction of actual results.
Investors should also be aware that while the Company might, from time to time, communicate with securities analysts, it is against the Company's policy to disclose to them any material non-public information or other confidential commercial information. Accordingly, investors should not assume that the Company agrees with any statement or report issued by any analyst irrespective of the content of the statement or report. Furthermore, the Company has a policy against issuing or confirming financial forecasts or projections issued by others.  Thus, to the extent that reports issued by securities analysts or others contain any projections, forecasts or opinions, such reports are not the responsibility of the Company.

In addition, the Company’s overall financial strategy, including growth in operations, maintaining financial ratios and strengthening the balance sheet, could be adversely affected by increased interest rates, construction delays or other transactions, economic slowdowns and changes in the Company’s plans, strategies and intentions.

Item 3.
Quantitative and Qualitative Disclosures About Market Risk.

Not applicable.

Item 4.
Controls and Procedures

Evaluation of Disclosure Controls and Procedures

We maintain disclosure controls and procedures that are designed to ensure that information required to be disclosed in the Company's reports under the Securities Exchange Act of 1934 is recorded, processed, summarized and reported within the time periods specified in the SEC's rules and forms, and that such information is accumulated and communicated to our management, as appropriate, to allow timely decisions regarding required disclosure.  Management recognizes that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives, and management necessarily was required to apply its judgment in evaluating the cost-benefit relationship of possible controls and procedures.  We do realize that we are a very small company and as a small company with only the officers and directors participating in the day to day management, with the ability to override controls, each officer and director has multiple positions and responsibilities that would normally be distributed among several employees in larger organizations with adequate segregation of duties to ensure the appropriate checks and balances.  Because the Company does not currently have a separate chief financial officer, the Chief Executive Officer performs these functions with the support of one of the Company’s outside directors who assists in the reporting and disclosure process (the “Lead Director”).
Our management evaluated the effectiveness of the design and operation of the Company’s disclosure controls and procedures (as such term is defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934) as of the end of the period covered by this report.  Based upon that evaluation the Company’s Chief Executive Officer concluded that the Company’s disclosure controls and procedures were not effective as of the end of the period covered by this report for the information required to be disclosed by the Company in the reports it files or submits under the Securities Exchange Act of 1934, as amended, to be recorded, processed, summarized and reported within the time periods specified in the Securities and Exchange Commission’s rules and forms, due to the material weakness in internal control over financial reporting described below.

Internal Control over Financial Reporting

Our management is responsible for establishing and maintaining adequate internal control over financial reporting (as such term is defined in Rules 13a-15(f) and 15d-15(f) under the Securities Exchange Act of 1934).  Internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with accounting principles generally accepted in the United States of America.  The Company’s internal control over financial reporting includes those policies and procedures that:

(i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the Company;

(ii) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with accounting principles generally accepted in the United States of America, and that receipts and expenditures of the Company are being made only in accordance with authorizations of management and directors of the Company; and

(iii) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use or disposition of the Company’s assets that could have a material effect on the financial statements.

Because of inherent limitations, internal control over financial reporting may not prevent or detect misstatements.  Therefore, even those systems determined to be effective can provide only reasonable assurance of achieving their control objectives.

Our management assessed the effectiveness of the Company’s internal control over financial reporting as of September 30, 2015 A material weakness is a control deficiency, or a combination of control deficiencies in internal controls over financial reporting, such that there is a reasonable possibility that a material misstatement of annual or interim financial statements will not be prevented or detected on a timely basis. In connection with the assessment described above, management identified the following material weakness as of September 30, 2015: the Company did not maintain sufficient qualified personnel with the appropriate level of knowledge, experience and training in the application of accounting principles generally accepted in the United States of America and in internal controls over financial reporting commensurate with its financial reporting requirements. Specifically, effective controls were not designed and in place to ensure that the Company maintained, or had access to, appropriate resources with adequate experience and expertise in the area of financial reporting for transactions such as lease financing, investments in unconsolidated entities, income taxes and guarantee obligations. The Company is in the process of developing efficient approaches to remediate this material weakness.  To do this in a cost-effective manner, considering the current extent of the Company’s operations, management is making arrangements with consultants and advisors to assist on an as-needed basis.
Changes in Internal Control over Financial Reporting

While there have not been any changes in the Company’s internal control over financial reporting (as such term is defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) during the fiscal quarter ended September 30, 2015, management is in the process of developing plans to remediate the material weakness identified above.

PART II - OTHER INFORMATION

Item 1.
Legal Proceedings

None

Item 2.
Unregistered Sales of Equity Securities and Use of Proceeds

Not applicable.

Item  3.
Defaults Upon Senior Securities

Not applicable.

Item 4.
Submission of Matters to a Vote of Security Holders

Not applicable.

Item 5.
Other Information

Not applicable.

Item 6.
Exhibits

31.1 Certification of President and Chief Executive Officer (Principal Executive Officer and Principal Financial Officer) pursuant to Rule 13a-14(a) of the Securities Exchange Act of 1934, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002, filed herewith.

32.1 Certification of President and Chief Executive Officer (Principal Executive Officer and Principal Financial Officer) pursuant to Rule 13a-14(b) of the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, filed herewith.

101 Interactive Data Files providing financial information from the Registrant’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2015 in XBRL (eXtensible Business Reporting Language).  Pursuant to Regulation 406T of Regulation S-T, these interactive data files are deemed not filed or part of a registration statement or prospectus for purposes of Section 11 or 12 of the Securities Act of 1933, as amended, or Section 18 of the Securities Exchange Act of 1934, as amended, and are otherwise not subject to liability.
SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

U.S. Neurosurgical Holdings, Inc.
(Registrant)
Date:  November 16, 2015
By:
/s/ Alan Gold
Alan Gold
Director, President and
Chief Executive Officer and
Principal Financial Officer
of the Registrant
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