American Shared Hospital Services (NYSEAMERICAN:AMS) executives said 2025 marked a “year of transition and investment” as the company continued shifting its business toward a direct patient care model while navigating pressure in its leasing segment and tighter liquidity conditions.
On the company’s fourth-quarter and full-year 2025 earnings call, Executive Chairman Ray Stachowiak pointed to the “strength and importance of our health system partnerships” as a foundation for growth, highlighting a new collaboration with Brown University Health in Rhode Island and a seven-year extension of a long-standing lease relationship with Orlando Health for a proton beam radiation therapy system.
Strategic shift toward direct patient care
CEO Gary Delanois said 2025 was “a foundational year” focused on expanding the direct patient care services platform and strengthening operational infrastructure. In Rhode Island, Delanois said the company worked with Brown University Health, Care New England, and CharterCARE Health Partners to “stabilize and rebuild” its radiation oncology physician team, adding that staffing has now been stabilized and that the company is “beginning to see improvements in treatment volumes,” which it expects to continue into 2026.
Delanois also cited efforts to improve revenue cycle management, saying the company has enhanced its billing and collections infrastructure to gain greater control and improve financial performance over time.
Q4 revenue declined; mix shift and lower volumes pressured margins
CFO Scott Frech reported fourth-quarter revenue fell 14.8% year over year to $7.7 million, down from $9.1 million. Frech attributed the decline primarily to the expiration of three Gamma Knife contracts and lower proton beam radiation therapy volumes.
- Direct patient care services revenue: $4.8 million, up 2.6% year over year, representing 63% of total revenue, driven by increased procedures in Puebla, Mexico and Rhode Island.
- Medical equipment leasing revenue: $2.9 million, down 33.9%, reflecting lower proton beam radiation therapy volumes and contract expirations.
Gross margin in the quarter was approximately $906,000, or 12% of revenue, compared with 35% in the fourth quarter of 2024. Frech said the change reflected lower treatment volumes and the continuing shift in revenue mix toward direct patient services.
Net loss attributable to the company improved to $631,000, or $0.09 per diluted share, compared with a net loss of $1.6 million, or $0.23 per diluted share, a year earlier. Adjusted EBITDA was $868,000, down from $3.8 million in the prior-year quarter.
Full-year results: stable revenue, but lower profitability and higher investment
For full-year 2025, Frech said total revenue was $28.1 million, compared with $28.3 million in 2024. Direct patient care services revenue increased 23.7% to $15.5 million, while leasing revenue declined to $12.6 million, which Frech characterized as consistent with the company’s strategic transition.
By modality, Frech reported:
- LINAC revenue: up 35.4% to $11.5 million
- Gamma Knife revenue: down 5.5% to $9.2 million
- Proton beam radiation therapy revenue: down 26% to $7.4 million
LINAC treatment sessions “more than doubled” to 28,147 in 2025, which Frech said reflected the first full year of operations for both Puebla and Rhode Island.
Gross margin for the year was $5.1 million, or 18% of revenue, compared with $9.2 million in 2024. Frech said the decline reflected increased operating costs and lower contributions from the leasing segment.
Net loss attributable to AMS was $1.6 million, or $0.23 per diluted share, compared with net income of $2.2 million in 2024. Frech noted 2024 results included a $3.8 million bargain purchase gain related to the Rhode Island acquisition. Adjusted EBITDA for 2025 was $5.5 million, compared with $8.9 million in 2024.
Liquidity, covenants, and lender discussions
Frech said AMS ended 2025 with approximately $3.7 million in cash, down from $11.3 million at the end of 2024. He attributed the decrease primarily to $7.5 million in capital expenditures tied to Rhode Island expansion and international investments.
Total debt at year-end was approximately $17.3 million, primarily associated with credit facilities. Frech said certain financial covenants were not met at year-end due to “lower profitability during our transition, higher operating costs and reduced leasing contributions.” He said the company is in “active and constructive discussions” with its lender regarding amendments and potential restructuring.
“While these conditions raise substantial doubt about our ability to continue as a going concern if unresolved,” Frech added, “we are confident in our path forward based on our ongoing lender engagement and improved operational performance.”
Frech also said shareholders’ equity, including non-controlling interests, was $24 million, or $3.66 per outstanding share, as of Dec. 31, 2025, compared with $25.2 million, or $3.92 per outstanding share, a year earlier.
Development pipeline: Rhode Island expansion and international growth
Delanois highlighted international operations as “a strong contributor and meaningful source of future opportunity.” He said AMS relocated its Lima, Peru center and upgraded its Gamma Knife to an Esprit platform, and added that performance in Puebla has “exceeded our expectations.” He also said AMS maintains leadership positions in Ecuador and Peru, where it operates the only Gamma Knife centers in those countries.
Looking ahead, Delanois said the company expects its Guadalajara, Mexico center to begin operations in 2026.
In Rhode Island, Delanois said the company has certificate of need approvals for a new radiation therapy treatment center in Bristol and a proton beam radiation therapy center in Johnston. In response to analyst questions, Delanois said the Bristol facility is anticipated to come online in “late 2027,” followed by the proton facility in “2028.” He added that AMS typically begins staffing “several months in advance” and can spread personnel across sites during ramp-up to manage expenses.
During the Q&A, an investor asked about the impact of expired contracts and whether investors should have been informed sooner. Stachowiak said the expirations had been mentioned in prior calls and disclosures and explained that quarterly comparisons can show negative variances depending on when agreements expired. The same investor asked whether the company expects profitability in 2026; Stachowiak said AMS “can’t speculate on that” and that the company has not been in the habit of giving forward-looking statements.
Asked about share repurchases, Frech said the company has not historically been interested in a buyback program and that, given the current situation with lenders, it is “unlikely to change that stance.”
In closing remarks, Delanois reiterated that 2025 investments were aimed at building a platform for growth, and said the company is focused on increasing treatment volumes, driving operational efficiencies, expanding with “disciplined development,” and leveraging partnerships to scale its model.
About American Shared Hospital Services (NYSEAMERICAN:AMS)
American Shared Hospital Services operates as a specialized healthcare services company focused on delivering diagnostic imaging solutions to community and rural hospitals across the United States. Through strategic joint ventures and management agreements, the company collaborates with hospital partners to develop and operate outpatient imaging centers that provide advanced modalities while sharing the capital and operating costs. By partnering directly with hospitals, American Shared Hospital Services enables facility owners to offer in-house diagnostic capabilities without the burden of full operational oversight and significant equipment investment.
The company’s service portfolio encompasses a wide range of imaging technologies, including magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography/computed tomography (PET/CT), mammography, ultrasound, bone densitometry (DEXA) and nuclear medicine.
