American Shared Hospital Services (NYSE American: AMS) reported financial results for the fourth quarter and full year ended December 31, 2025, revealing a net loss of $1.6 million for the year compared to net income of $2.2 million in 2024. The company also announced a seven-year extension of its proton beam radiation therapy lease agreement with Orlando Health, Inc., through 2033, underscoring the long-term nature of its partnerships.
Full year 2025 total revenue was $28.1 million, slightly down from $28.3 million in 2024. Revenue from direct patient care services increased 23.7% 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 revenue grew 35.4% to $11.5 million, while Gamma Knife revenue fell 5.5% to $9.2 million and proton beam radiation therapy (PBRT) revenue declined 26.0% to $7.4 million.
Gary Delanois, CEO, stated that 2025 was a year of transition and operational expansion. The company integrated the Rhode Island centers and completed the first full year of operations in Puebla, Mexico. Same-center Gamma Knife procedure volumes improved following equipment upgrades, and the company upgraded its Gamma Knife unit in Lima, Peru to the Esprit platform to support future patient growth.
Ray Stachowiak, Executive Chairman, highlighted the strategic shift toward direct patient care services, which strengthens long-term growth potential and creates more stable revenue streams. The company has received Certificate of Need approvals for a radiation therapy treatment center in Bristol, Rhode Island and a proton beam radiation therapy center in Johnston, Rhode Island, with permitting activities underway.
Scott Frech, CFO, noted that the company is focused on driving revenue growth and anticipates additional contributions from the new Esprit at the Guadalajara, Mexico Gamma Knife center. He also mentioned ongoing discussions with the lender to optimize the balance sheet and strategic flexibility, as certain financial covenants under the credit facility were not met as of December 31, 2025.
For the fourth quarter of 2025, total revenue decreased 14.8% to $7.7 million compared to $9.1 million in the prior year period, driven by the expiration of three Gamma Knife agreements and lower PBRT volumes. Direct patient care services revenue increased 2.6% to $4.9 million, representing 63% of total sales. Medical equipment leasing revenue decreased 33.9% to $2.9 million. Gross margin was 12% compared to 35% in Q4 2024, due to lower treatment volumes and increased operating costs from the shift to direct patient care.
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, driven by $7.5 million in capital expenditures. Shareholders' equity was $24.0 million, or $3.66 per share. The company ended the quarter with eight domestic medical equipment leasing agreements and six direct patient care service centers operating in the United States and Latin America.
