American Shared Hospital Services (AMS) investor relations material

Executive summary

• 2025 marked a year of transition, with stable total revenue at $28.1 million, down 0.9% year-over-year, and a strategic shift toward direct patient care, now the majority of revenue, driven by new centers in Rhode Island and Puebla, Mexico.

• Strengthened partnerships, notably with Brown University Health and a seven-year lease extension with Orlando Health through 2033, supported operational stability and growth.

• Operational challenges included physician turnover, reimbursement issues, leasing segment headwinds, and contract expirations, but decisive actions were taken to address these.

• Expansion of clinical capabilities, infrastructure improvements, and technology upgrades, such as the Esprit Gamma Knife in Lima, Peru, positioned the company for long-term growth.

• LINAC revenue grew 35.4% year-over-year, while Gamma Knife and PBRT revenues declined 5.5% and 26%, respectively.

Financial highlights

• Q4 2025 revenue declined 14.8% year-over-year to $7.7 million, mainly due to expired Gamma Knife contracts and lower proton therapy volumes.

• Direct patient care services revenue rose 23.7% to $15.5 million for the year, while leasing revenue fell to $12.6 million.

• Gross margin for the year was $5.1 million (18% of revenue), down from $9.2 million (32%) in 2024, reflecting higher costs and lower leasing contributions.

• Net loss attributable to the company was $1.6 million, or $0.23 per diluted share, compared to net income of $2.2 million in 2024 (which included a $3.8 million one-time gain).

• Adjusted EBITDA for 2025 was $5.5 million, down from $8.9 million in 2024.

Outlook and guidance

• Optimism for 2026, with expectations for increased treatment volumes, operational efficiencies, and margin improvement, while focusing on optimizing operations at existing centers and expanding patient access.

• Expansion plans include new centers in Rhode Island (Bristol in late 2027, proton facility in 2028), Guadalajara, Mexico, and permitting underway for new centers in Bristol and Johnston, Rhode Island.

• Anticipates additional revenue from the new Esprit Gamma Knife in Guadalajara, Mexico.

• No specific profitability guidance for 2026 was provided.