Second quarter and six months ended June 30, 2026
Filed Aug 13, 2026Second Quarter Revenue Increased 19% to $8.4 Million Driven by Strong Growth from Direct Patient Services
Second-quarter revenue increased 19%, led by Direct Patient Services and Proton Beam Radiation Therapy, but gross margin declined year over year, adjusted EBITDA declined, and net loss attributable to American Shared Hospital Services widened. The Company also entered into a Third Amendment and Forbearance Agreement and obtained subordinated financing subsequent to quarter end.
Key metrics
as reported| Metric | Value | q/q | y/y |
|---|---|---|---|
| Revenue, three months ended June 30, 2026GAAP | $8,430,000 | – | 19% |
| Costs of revenue, three months ended June 30, 2026GAAP | $6,997,000 | – | – |
| Gross margin, three months ended June 30, 2026GAAP | $1,433,000 | – | – |
| Selling and administrative expense, three months ended June 30, 2026GAAP | $2,042,000 | – | – |
| Interest expense, three months ended June 30, 2026GAAP | $301,000 | – | – |
| Operating loss, three months ended June 30, 2026GAAP | $(910,000) | – | – |
| Interest and other income, three months ended June 30, 2026GAAP | $47,000 | – | – |
| Loss before income taxes, three months ended June 30, 2026GAAP | $(863,000) | – | – |
| Income tax expense (benefit), three months ended June 30, 2026GAAP | $135,000 | – | – |
| Net loss, three months ended June 30, 2026GAAP | $(998,000) | – | – |
| Net loss attributable to non-controlling interest, three months ended June 30, 2026GAAP | $484,000 | – | – |
| Net loss attributable to American Shared Hospital Services, three months ended June 30, 2026GAAP | $(514,000) | – | – |
| Basic loss per common share, three months ended June 30, 2026GAAP | $(0.07) | – | – |
| Diluted loss per common share, three months ended June 30, 2026GAAP | $(0.07) | – | – |
| Weighted average basic shares outstanding, three months ended June 30, 2026other | 6,872,000 | – | – |
| Weighted average diluted shares outstanding, three months ended June 30, 2026other | 6,872,000 | – | – |
| Adjusted EBITDA, three months ended June 30, 2026non-GAAP | $1,341,000 | – | – |
| Revenue, six months ended June 30, 2026GAAP | $15,514,000 | – | 18% |
| Costs of revenue, six months ended June 30, 2026GAAP | $12,793,000 | – | – |
| Gross margin, six months ended June 30, 2026GAAP | $2,721,000 | – | – |
| Selling and administrative expense, six months ended June 30, 2026GAAP | $3,952,000 | – | – |
| Interest expense, six months ended June 30, 2026GAAP | $603,000 | – | – |
| Operating loss, six months ended June 30, 2026GAAP | $(1,834,000) | – | – |
| Interest and other income, six months ended June 30, 2026GAAP | $101,000 | – | – |
| Loss before income taxes, six months ended June 30, 2026GAAP | $(1,733,000) | – | – |
| Income tax expense (benefit), six months ended June 30, 2026GAAP | $227,000 | – | – |
| Net loss, six months ended June 30, 2026GAAP | $(1,960,000) | – | – |
| Net loss attributable to non-controlling interest, six months ended June 30, 2026GAAP | $834,000 | – | – |
| Net loss attributable to American Shared Hospital Services, six months ended June 30, 2026GAAP | $(1,126,000) | – | – |
| Basic loss per common share, six months ended June 30, 2026GAAP | $(0.17) | – | – |
| Diluted loss per common share, six months ended June 30, 2026GAAP | $(0.17) | – | – |
| Weighted average basic shares outstanding, six months ended June 30, 2026other | 6,737,000 | – | – |
| Weighted average diluted shares outstanding, six months ended June 30, 2026other | 6,737,000 | – | – |
| Adjusted EBITDA, six months ended June 30, 2026non-GAAP | $2,465,000 | – | – |
| Cash provided by operating activities, six months ended June 30, 2026GAAP | $4.4 million | – | – |
Segments
| Segment | Revenue | q/q | y/y |
|---|---|---|---|
| Direct Patient ServicesHigher procedure volumes at the Company's Rhode Island radiation therapy centers and its Peru and Puebla, Mexico facilities. | $4.9 million | – | 40% |
| Proton Beam Radiation TherapyHigher treatment volumes and improved average reimbursement. | $2.3 million | – | 22% |
| Gamma KnifeInternational Gamma Knife procedure volumes continued to improve following installation of the Esprit system upgrade in Lima, Peru during 2025. | $2.7 million | – | – |
What drove it
- Direct Patient Services revenue increased 40% to $4.9 million, driven by higher procedure volumes at Rhode Island and Peru and Puebla, Mexico facilities.
- Proton Beam Radiation Therapy revenue increased 22% to $2.3 million, driven by higher treatment volumes and improved average reimbursement.
- Proton Beam Radiation Therapy treatment fractions increased approximately 10% year over year.
- International Gamma Knife procedure volumes increased, especially at the Peru facility.
- The Esprit system upgrade in Lima, Peru reduced treatment times and improved patient throughput.
Concerns
- Gross margin was $1,433,000 in the second quarter of 2026, compared with $1,630,000 in the second quarter of 2025.
- Second-quarter adjusted EBITDA was $1,341,000, compared with $1,701,000 in the prior-year quarter.
- Net loss attributable to American Shared Hospital Services was $(514,000), compared with $(280,000) in the second quarter of 2025.
- The increase in net loss reflected legal costs of $285,000 associated with the completed Third Amendment to the credit agreement and an increase in the allowance for credit losses of $909,000 for accounts receivable prior to May 31, 2025.
- Medical Equipment Leasing revenue remained generally consistent with the prior-year quarter because lower domestic Gamma Knife procedure volumes, primarily reflecting the expiration of one customer contract in 2025, offset strength in Proton Beam Radiation Therapy operations.
- The Company continues to address financing initiatives and longer-term capital structure alternatives.
What to watch
- Direct Patient Services procedure volumes at the Rhode Island radiation therapy centers and Peru and Puebla, Mexico facilities.
- Proton Beam Radiation Therapy treatment volumes and average reimbursement.
- International Gamma Knife patient throughput following the Esprit system upgrade in Lima, Peru.
- Domestic Gamma Knife leasing volumes following the expiration of one customer contract in 2025.
- Execution of the revised repayment schedule, financing initiatives, and longer-term capital structure alternatives.
- Operating efficiencies, patient access expansion, and collections related to the allowance for credit losses.
Balance sheet and cash flow
- Cash, cash equivalents and restricted cash were $6,761,000 as of June 30, 2026, compared with $3,712,000 at December 31, 2025.
- Current portion of long-term debt, net was $16.2 million as of June 30, 2026, compared with $17.3 million at December 31, 2025.
- Current assets were $17,368,000 as of June 30, 2026, compared with $17,720,000 at December 31, 2025.
- Total assets were $52,493,000 as of June 30, 2026, compared with $55,479,000 at December 31, 2025.
- Current liabilities were $22,424,000 as of June 30, 2026, compared with $23,444,000 at December 31, 2025.
- Shareholders' equity, excluding non-controlling interests, was $23,111,000 as of June 30, 2026, compared with $24,034,000 at December 31, 2025.
- Outstanding shares were 6,625,000 as of June 30, 2026, compared with 6,575,000 at December 31, 2025.
- Subsequent to quarter end, the Company entered into a Third Amendment to its Credit Agreement and Forbearance Agreement with Fifth Third Bank.
- In conjunction with the amendment, the Company secured $2.0 million of subordinated financing from RCS/TIG Holdings LLC.
- Cash generated from operations primarily funded scheduled debt repayments and distributions to non-controlling interests during the period.
Analysis
American Shared Hospital Services reported second-quarter revenue of $8,430,000, compared with $7,071,000 in the prior-year period. Direct Patient Services revenue increased 40% to $4.9 million on higher procedure volumes at the Rhode Island, Peru, and Puebla facilities. Proton Beam Radiation Therapy revenue increased 22% to $2.3 million as higher treatment volumes and improved average reimbursement supported results. Gamma Knife revenue increased to $2.7 million from $2.6 million, with international volumes improving after the Esprit system upgrade in Lima, Peru.
Revenue growth did not translate into year-over-year gross-margin or EBITDA expansion. Gross margin was $1,433,000, compared with $1,630,000, though it was up from $1.3 million in Q1 2026. Selling and administrative expense was $2,042,000, compared with $1,746,000. Operating loss was $(910,000), compared with $(544,000), while adjusted EBITDA was $1,341,000 versus $1,701,000.
Net loss attributable to American Shared Hospital Services was $(514,000), or $(0.07) per diluted share, compared with $(280,000), or $(0.04) per diluted share. Management attributed the increased loss primarily to $285,000 of legal costs associated with the Third Amendment to the credit agreement and a $909,000 increase in the allowance for credit losses for accounts receivable prior to May 31, 2025. For the six-month period, revenue increased 18% to $15,514,000, while adjusted EBITDA was $2,465,000 compared with $2,650,000.
Operating cash flow was $4.4 million during the first six months of 2026 and primarily funded scheduled debt repayments and distributions to non-controlling interests. Cash, cash equivalents and restricted cash were $6,761,000 at June 30, 2026, compared with $3,712,000 at December 31, 2025, while the current portion of long-term debt, net was $16.2 million. Subsequent to quarter end, the Company amended its Fifth Third Bank credit agreement and obtained $2.0 million of subordinated financing from RCS/TIG Holdings LLC to provide additional liquidity and flexibility while it pursues capital structure alternatives.
Management, verbatim
Our second quarter results demonstrate the strength of our diversified radiation oncology platform.
Craig Tagawa, Interim Chief Executive Officer
Our quarterly revenue growth reflects continued momentum in our Direct Patient Services business, improved Proton Beam Radiation Therapy performance and increasing contributions from our international operations.
Craig Tagawa, Interim Chief Executive Officer
The fundamentals of our business remain strong. Demand for advanced radiation therapy continues to grow, and our portfolio of Gamma Knife, Proton Beam Radiation Therapy and radiation oncology centers positions AMS to participate across multiple areas of cancer treatment.
Ray Stachowiak, Executive Chairman
Not in the filing
stated, not guessed- Forward revenue, gross margin, operating expense, tax rate, and other financial guidance were not provided.
- Previous-quarter comparisons were not provided for revenue, costs of revenue, selling and administrative expense, operating loss, net loss, EPS, adjusted EBITDA, or segment revenue.
- GAAP gross margin percentage was not provided.
- Free cash flow was not provided.
- Cash flow from investing activities and cash flow from financing activities were not provided.
- Total long-term debt, net debt, and debt maturity amounts were not provided.
- Share repurchases and dividends were not provided.
- A quantitative second-quarter Medical Equipment Leasing revenue figure was not provided.
- A second-quarter Gamma Knife year-over-year percentage change was not provided.
- Prior-year operating cash flow was not provided.
AlphaAI analysis generated from the company’s SEC earnings filing (Form 8-K Item 2.02, or Form 6-K for a foreign private issuer). Every figure was cross-checked against the filing text; consensus estimates, price targets and share-price reactions are not shown because they are not in the filing. AI-generated research, not investment advice.