American Shared Hospital Services (NYSE American: AMS) reported financial results for the fourth quarter and full year ended December 31, 2025, highlighting a net loss attributable to the company of $1.6 million, or $0.23 per diluted share, compared with net income of $2.2 million, or $0.33 per diluted share, in 2024. Total revenue for the full year was $28.1 million, a slight decline from $28.3 million in the prior year. The company also announced a seven-year extension of its proton beam radiation therapy lease agreement with Orlando Health, Inc., extending through 2033.
The shift toward direct patient care services continued to reshape the company's revenue mix. Direct patient care revenue increased 23.7% year-over-year to $15.5 million, driven by the first full year of operations at three radiation therapy centers in Rhode Island and a center in Puebla, Mexico. LINAC treatment sessions more than doubled to 28,147 in 2025 from 14,662 in 2024. However, the equipment leasing segment faced headwinds, with revenue declining to $12.6 million from $15.6 million due to the expiration of three Gamma Knife agreements and lower proton therapy volumes. Gamma Knife procedures declined 13.6% overall but same-center procedures increased 11.3% after equipment upgrades.
The company's strategic expansion in Rhode Island advanced with Certificate of Need approvals for a radiation therapy center in Bristol and a proton beam radiation therapy center in Johnston. Permitting activities are underway for the Bristol facility. Internationally, the company completed an upgrade of its Gamma Knife unit in Lima, Peru, to the Esprit platform, positioning the center for expanded treatment capabilities.
Chief Executive Officer Gary Delanois noted that 2025 was a year of transition and operational expansion, with successful integration of the Rhode Island centers and navigation through key Radiation Oncologist recruitment initiatives. He emphasized the importance of the Orlando Health lease extension, stating it underscores the long-term nature of the company's relationships and collaboration in delivering advanced cancer treatment services using proton beam radiation therapy.
Executive Chairman Ray Stachowiak highlighted the strategic shift toward direct patient care services as a driver of long-term growth and stable revenue streams. He pointed to new business development initiatives and the Rhode Island expansions as catalysts for continued momentum.
For the fourth quarter of 2025, total revenue fell 14.8% to $7.7 million from $9.1 million in the prior year period, driven by lower leasing revenue. Direct patient care services accounted for 63% of total sales, up from 52% a year earlier. Gross margin declined to 12% from 35%, reflecting increased operating costs from the shift to direct patient care, which carries lower margins than equipment leasing. Adjusted EBITDA, a non-GAAP measure, was $868,000 for the quarter, compared with $3.8 million in Q4 2024.
As of December 31, 2025, the company had $3.7 million in cash and cash equivalents, including restricted cash, down from $11.3 million a year earlier due to $7.5 million in capital expenditures. Total current portion of long-term debt was approximately $17.3 million. The company noted that certain financial covenants under its credit facility were not met and that it is engaged in constructive discussions with its lender to secure waivers or amendments. Shareholders' equity stood at $24.0 million, or $3.66 per share.
Chief Financial Officer Scott Frech stated that the company remains focused on driving revenue growth and optimizing its balance sheet, with ongoing discussions with the lender. He highlighted that the company's market value reflects a steep discount to underlying shareholders' equity of $3.66 per share.
Looking ahead, the company expects contributions from the new Esprit platform in Guadalajara, Mexico, and continued momentum in Rhode Island and international operations. The company will hold a conference call at 12:00 PM ET today to discuss results.
